Using point-of-care lung ultrasound to explore how TB severity affects people’s socio-economic status

ISRCTN ISRCTN87512724
DOI https://doi.org/10.1186/ISRCTN87512724
Secondary identifying numbers NIHR156579
Submission date
14/08/2025
Registration date
04/09/2025
Last edited
26/08/2025
Recruitment status
Not yet recruiting
Overall study status
Ongoing
Condition category
Infections and Infestations
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
Tuberculosis (TB) remains a major global health challenge, especially in low-resource settings where timely diagnosis and treatment are often limited. People with lower socioeconomic status tend to face more barriers to early TB diagnosis, which can lead to more severe illness, worse health outcomes, and continued transmission in their communities. In turn, severe TB can deepen financial hardship through high treatment costs and lost income, creating a cycle in which poverty and TB reinforce each other.
The World Health Organization (WHO) recommends active screening for people at higher risk of TB. Conventional screening methods, such as chest X-rays, can be effective but are often unavailable in remote areas due to the need for specialized equipment and trained staff. Point-of-care ultrasound (POCUS) offers a portable and promising alternative for screening and monitoring TB, potentially enabling earlier diagnosis and improving patients’ socioeconomic circumstances.
This study aims to explore the relationship between TB severity and its socioeconomic impacts, as well as to evaluate the use of POCUS for early TB diagnosis and disease severity assessment, and its potential role in improving patients’ economic and social well-being.

Who can participate?
Adults recently diagnosed with TB who are receiving care at a health facility (cases), and adults randomly selected from the community (controls)

What does the study involve?
Baseline visit: After obtaining informed consent, all participants will complete an interview to assess socioeconomic status, followed by a physical examination (including measurements such as weight and height) and a point-of-care ultrasound (POCUS). Relevant clinical data will also be extracted from participants’ medical records.
Follow-up visits: Only participants with TB (cases) will be followed up at 2 and 6 months after starting treatment. At each follow-up, they will undergo repeat socioeconomic interviews, physical examinations and measurements, POCUS, and medical record review

What are the possible benefits and risks for participants?
Potential benefits for participants are:
1. Free use of a simple, safe and non-invasive tool which could identify prior undiagnosed medical problems
2. TB screening in community controls, who in the event that they are positive will be referred for care and treatment initiation
3. In cases, people living with TB, provision of direct drug-susceptibility testing that is currently not routinely provided by the National TB program. In the event that drug resistance is identified, the results will be shared with the participants and the local physicians for management
4. Other quick referrals for identified problems
5. Other quicker results feedback than the routine standard of care
Wider community potential benefits are:
1. Contribute to the availability of a tool that was previously not available at the health facilities
2. Opportunity to partake in a potential landmark study that could influence future policy
3. Training of facility radiographers in lung ultrasound and therefore capacitating health facilities
4. Potential better TB treatment monitoring, allowing better clinical management, reducing resistance and transmission within communities and improving progress towards the goal of ending tuberculosis
We do not anticipate any potential risk for participants and ultrasound is a non-invasive tool. There might be, however, potential discomfort derived from exposure of the upper body for obtaining ultrasound images, or from HIV testing, which may cause mild discomfort too and learning about HIV status may cause distress.

Where is the study run from?
Asociacion Benéfica PRISMA (Peru)

When is the study starting and how long is it expected to run from?
March 2025 to March 2027

Who is funding the study?
National Institute for Health and Care Research (NIHR) (UK)

Who is the main contact?
1. Dr Freddy Tinajeros, ftinajeros@gmail.com, ftinajeros@prisma.org.pe
2. Dr Paula Carballo, paulacarballo.md@gmail.com, pcarballo@prisma.org.pe
3. Dr Carlos Lou, carlos.a.lou.dan@gmail.com, clou@prisma.org.pe
4. Dr Maria Ruperez, maria.ruperez@lshtm.ac.uk
5. Prof. Helen Ayles, Helen@zambart.org.zm

Study website

Contact information

Dr Freddy Tinajeros
Public, Scientific, Principal Investigator

Av. Guardia Civil 1321
Lima
15036
Peru

Phone +51 (0)1 2090400
Email ftinajeros@gmail.com
Dr Carlos Lou
Public, Scientific

Av. Guardia Civil 1321
Surquillo
Lima
15036
Peru

Phone +51 (0)1 2090400
Email carlos.a.lou.dan@gmail.com
Dr Paula Carballlo
Public, Scientific

Av. Guardia Civil 1321
Lima
15036
Peru

Phone +51 (0)1 2090400
Email paulacarballo.md@gmail.com
Dr Maria Ruperez
Public, Scientific

Keppel Street
London
WC1E 7HT
United Kingdom

ORCiD logoORCID ID 0000-0001-8322-7881
Phone +44 (0)20 7636 8636
Email maria.ruperez@lshtm.ac.uk
Prof Helen Ayles
Principal Investigator

Keppel street
London
WC1E 7HT
United Kingdom

ORCiD logoORCID ID 0000-0003-4108-2842
Phone +44 (0)20 7636 8636
Email Helen@zambart.org.zm

Study information

Study design2:1 case-control study (cases are participants diagnosed with TB versus community controls) with a nested prospective cohort of participants diagnosed with TB
Primary study designObservational
Secondary study designCase-control study
Study setting(s)Community, Hospital, Medical and other records
Study typeOther, Screening
Participant information sheet Not available in web format, please use contact details to request a participation information sheet
Scientific titlePoint-Of-Care Ultrasound for Tuberculosis Formative Prospective case-control study with nested cohort in Bolivia: characterising associations between disease severity and the socioeconomic consequences of TB
Study acronymPOCUS4TB_Bolivia
Study objectivesTuberculosis (TB) remains a global health concern, particularly in low-resource settings where access to diagnostics and timely treatment is limited. Lower socioeconomic status is associated with reduced access to timely tuberculosis diagnosis, contributing to increased disease severity and poorer outcomes, as well as ongoing transmission within communities. In turn, greater disease severity can exacerbate socioeconomic hardship through catastrophic health-related costs, creating a reinforcing cycle between poverty and TB.

The WHO recommends actively screening populations at higher risk of TB. While conventional screening tools such as chest X-rays are useful, they are often inaccessible in remote areas due to the need for specialized equipment and personnel. Point-of-Care Ultrasound (POCUS) has emerged as a promising, portable alternative for screening and monitoring TB, which could lead to easier access and early diagnosis of TB and potentially improve the socioeconomic conditions of patients.

In this study we aim to better understand associations between TB disease severity and the socioeconomic consequences of TB disease. As well as assessing the use of POCUS for early diagnosis of TB and for assessing TB disease severity, and its role in improving patients´ socio-economic status.
Ethics approval(s)

1. Submitted 31/03/2025, London School of Hygiene and Tropical Medicine (Keppel Street, London, WC1E 7HT, United Kingdom; +44 (0)20 7636 8636; ethics@lshtm.ac.uk), ref: 32195

2. Submitted 08/04/2025, PRISMA ethics committee (Av. Guardia Civil 1321, Lima, 15036, Peru; +51 (0)(511) 209 0400; prisma@prisma.org.pe), ref: CEO136.25

3. Submitted 17/04/2025, Universidad Catolica Boliviana (Av. 14 de Septiembre Nº 4807, La Paz, 00591, Bolivia; +591 (2) 278‑222; coonalinv.cba@ucb.edu.bo), ref: N/A

Health condition(s) or problem(s) studiedTuberculosis
InterventionThis is a 2:1 case-control study, in which adults recently diagnosed with TB attending a health care facility will be invited to participate (cases), as well as adults randomly selected from the community (controls).

Baseline Visit:
After obtaining informed consent, participants will undergo interviews to assess socioeconomic status, and a physical examination, including measurements such as weight and height, will be conducted together with a point-of-care ultrasound (POCUS). Clinical data will be collected from participants´ records.

Follow-up Visits:
Follow-up visits will be conducted only for participants diagnosed with TB (cases) at 2 and 6 months post-treatment, with repeat interviews to assess socioeconomic status, physical examination and measures, data collection from medical records and POCUS.

The study will focus on using POCUS to better understand TB disease severity and its socioeconomic impact. POCUS images will also be used to train an AI model that could improve TB screening and triage in the future.
Intervention typeOther
Primary outcome measureDiagnostic performance of point-of-care ultrasound (POCUS) for detecting tuberculosis is measured in terms of sensitivity, specificity, positive predictive value, and negative predictive value, by comparing interpretation of ultrasound images by two independent readers to bacteriologically and/or clinically confirmed TB at baseline visit
Secondary outcome measures1. Socioeconomic status measured using TB-household income at baseline
2. TB-related costs measured using a questionnaire designed for this purpose at baseline
3. Quality of life measured using the WHO BREF QOL questionnaire at baseline
4. Disease severity measured using symptom duration, body mass index, sputum mycobacterial concentration and POCUS images interpreted by two independent readers in participants with TB (cases) at baseline and 2 and 6 months
Overall study start date31/03/2025
Completion date31/03/2027

Eligibility

Participant type(s)Healthy volunteer, Patient
Age groupAdult
Lower age limit18 Years
Upper age limit100 Years
SexBoth
Target number of participants300 (200 cases and 100 controls)
Key inclusion criteriaFor participants diagnosed with TB (cases):
1. Aged ≥18 years old
2. Receiving or will receive treatment for pulmonary TB at the selected health centre

For community controls:
1. Aged ≥18 years old
2. Resides in the selected community
Key exclusion criteriaFor participants diagnosed with TB (cases):
1. Started treatment >2 weeks for the current TB episode
2. Refusing to provide informed consent/assent to participate in the study

For community controls:
1. Received TB treatment <1 year ago
2. Refusing to provide informed consent/assent to participate in the study
3. Serious illness resulting in unstable condition or life-threatening participation in the study
Date of first enrolment15/09/2025
Date of final enrolment01/10/2026

Locations

Countries of recruitment

  • Bolivia
  • Peru

Study participating centre

Asociación benéfica PRISMA
Av. Guardia Civil 1321
Lima
15036
Peru

Sponsor information

London School of Hygiene & Tropical Medicine
University/education

Keppel Street
London
WC1E 7HT
England
United Kingdom

Phone +44 (0)20 7636 8636
Email Helen@zambart.org.zm
Website http://www.lshtm.ac.uk/
ROR logo "ROR" https://ror.org/00a0jsq62
Prisma
Charity

Av. Guardia Civil 1321
Lima
15036
Peru

Phone +51 (0)1 2090400 (246)
Email ftinajeros@gmail.com
Website https://www.prisma.org.pe/
ROR logo "ROR" https://ror.org/011y8cj77

Funders

Funder type

Government

National Institute for Health and Care Research
Government organisation / National government
Alternative name(s)
National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
Location
United Kingdom

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryStored in publicly available repository
Publication and dissemination plan
IPD sharing planThe datasets generated during and/or analysed during the current study will be stored in a publicly available repository (yet to be confirmed)

Editorial Notes

26/08/2025: Study's existence confirmed by the NIHR.