{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:46:26Z","timestamp":1790289986712,"version":"4.1.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T00:00:00Z","timestamp":1678320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Finance, Lesotho, Global Fund PR","award":["GF\/R8\/TB\/C03-NPBTBPS"],"award-info":[{"award-number":["GF\/R8\/TB\/C03-NPBTBPS"]}]},{"name":"World Bank Southern Africa Health System Support project"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The Kingdom of Lesotho has one of the highest burdens of tuberculosis (TB) in the world. A national TB prevalence survey was conducted to estimate the prevalence of bacteriologically confirmed pulmonary TB disease among those \u226515 years of age in 2019.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>A multistage cluster-based cross-sectional survey where residents \u226515 years in 54 clusters sampled from across the country were eligible to participate. Survey participants were screened using a symptom screen questionnaire and digital chest X-ray (CXR). Respondents who acknowledged cough of any duration, fever, weight loss, night sweats and\/or had any CXR abnormality in the lungs were asked to provide two spot sputum specimens. All sputum testing was conducted at the National TB Reference Laboratory (NTRL), where samples underwent Xpert MTB\/RIF Ultra (1<jats:sup>st<\/jats:sup> sample) and MGIT culture (2<jats:sup>nd<\/jats:sup> sample). HIV counselling and testing was offered to all survey participants. TB cases were those with <jats:italic>Mycobacterium tuberculosis<\/jats:italic> complex-positive samples with culture; and where culture was not positive, Xpert MTB\/RIF Ultra (Xpert Ultra) was positive with a CXR suggestive of active TB and no current or prior history of TB.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Result<\/jats:title>\n<jats:p>A total of 39,902 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to participate; 21,719 (80.9%) participated in the survey of which 8,599 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey participants underwent symptom screening and a total of 21,344 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only, 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and 311 (4.1%) submitted one sample only. From the 21,719 survey participants, HIV counseling and testing was offered to 17,048, and 3,915 (23.0%) were documented as HIV-positive. The survey identified 132 participants with bacteriologically confirmed pulmonary TB thus providing an estimated prevalence of 581 per 100,000 population (95% CI 466\u2013696) for those \u226515 years in 2019. Using the survey results, TB incidence was re-estimated to be 654 per 100,000 (95% CI 406\u2013959), which was comparable to the 2018 TB incidence rate of 611 per 100,000 (95% CI 395\u2013872) reported by the World Health Organization (WHO). The highest TB burden was found in those \u226555 years and among men. The ratio of prevalence to case notification was estimated at 1.22. TB\/HIV coinfection was identified in 39 (29.6%) participants. Out of the 1,825 participants who reported a cough, 50% of these participants, mostly men, did not seek care. Those who sought care predominantly went to the public health facilities.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The TB prevalence survey results confirmed that burden of TB and TB\/HIV coinfection remains very high in Lesotho. Given that TB prevalence remains high, and there is a significant proportion of participants with confirmed TB that did not report TB suggestive symptoms. The National TB Programme will need to update its TB screening and treatment algorithms to achieve the End TB targets. A major focus will need to be placed on finding the \u201cmissing cases\u201d i.e., undiagnosed or under-reported TB cases, or ensuring that not only TB symptomatic but also those who do not present with typical TB symptoms are promptly identified to reduce further onward transmission.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0273245","type":"journal-article","created":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T18:46:11Z","timestamp":1678387571000},"page":"e0273245","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Policy and programmatic directions for the Lesotho tuberculosis programme: Findings of the national tuberculosis prevalence survey, 2019"],"prefix":"10.1371","volume":"18","author":[{"given":"R.","family":"Matji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Maama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Roscigno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Lerotholi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Agonafir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Sekibira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1194-677X","authenticated-orcid":true,"given":"I.","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Tadolini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0264-9025","authenticated-orcid":true,"given":"N.","family":"Kak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,9]]},"reference":[{"key":"pone.0273245.ref001","unstructured":"Bureau 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tuberculosis in South Africa, 2017\u201319: a multistage, cluster-based, corss-sectional survey","author":"S Moyo","journal-title":"Lancet May 17"},{"key":"pone.0273245.ref011","volume-title":"Global Tuberculosis Report","author":"World Health Organization","year":"2020"},{"key":"pone.0273245.ref012","volume-title":"Global Tuberculosis Report","author":"World Health Organization","year":"2019"},{"issue":"9","key":"pone.0273245.ref013","doi-asserted-by":"crossref","first-page":"e1002119","DOI":"10.1371\/journal.pmed.1002119","article-title":"Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis","volume":"13","author":"KC Horton","year":"2016","journal-title":"PLoS Med"},{"issue":"2","key":"pone.0273245.ref014","doi-asserted-by":"crossref","first-page":"e1002754","DOI":"10.1371\/journal.pmed.1002754","article-title":"Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care","volume":"16","author":"R Subbaraman","year":"2019","journal-title":"PLoS Med"},{"key":"pone.0273245.ref015","volume-title":"WHO consolidated guidelines on tuberculosis. Module 2: screening\u2013systematic screening for tuberculosis disease","author":"World Health Organization","year":"2021"},{"issue":"3","key":"pone.0273245.ref016","doi-asserted-by":"crossref","first-page":"e830","DOI":"10.1093\/cid\/ciaa1402","article-title":"Subclinical Tuberculosis Disease-A Review and Analysis of Prevalence Surveys to Inform Definitions, Burden, Associations, and Screening Methodology","volume":"73","author":"B Frascella","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0273245.ref017","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S1473-3099(17)30691-6","article-title":"Xpert MTB\/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study","volume":"18","author":"SE Dorman","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pone.0273245.ref018","first-page":"2","article-title":"Xpert Ultra versus Xpert MTB\/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis","author":"JS Zifodya","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0273245.ref019","volume-title":"Assessing tuberculosis under-reporting through inventory studies","author":"World Health Organization","year":"2014"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0273245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T18:46:28Z","timestamp":1678387588000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0273245"}},"subtitle":[],"editor":[{"given":"Kevin","family":"Schwartzman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,3,9]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0273245","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,9]]}}}