scholarly journals Strategies for active detection of tuberculosis in Ukraine: Comparative effectiveness amongst key populations (2014-2018)

2019 ◽  
Vol 13 (07.1) ◽  
pp. 89S-94S
Author(s):  
Natalia Kamenska ◽  
Dilyara Nabirova ◽  
Karapet Davtyan ◽  
Hayk Davtyan ◽  
Rony Zachariah ◽  
...  
Keyword(s):  
Sex Workers ◽  
Case Finding ◽  
Key Populations ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Treatment ◽  
Number Needed To Screen ◽  
Symptom Screening ◽  
Specimen Collection ◽  
Sex With Men

Introduction: Ukraine has gaps in Tuberculosis (TB) service coverage, especially in key populations (KPs). We compared effectiveness of three different strategies for active TB detection among KPs and their linkage to TB treatment during three time periods. Methodology: The KPs included people who inject drugs (PWID), sex workers (SW), men who have sex with men (MSM) and groups at-risk of TB (ex-prisoners, Roma and homeless). The active case finding included decentralized symptom screening and specimen collection (2014, strategy-1), decentralized screening with patient referred for specimen collection (2015-2017, strategy-2) and strategy-2 plus GeneXpert (2018, strategy-3). Results: In total 680,760 KPs were screened, of whom 68% were PWID. TB case detection per 100,000 populations was 1,191 in strategy-1, 302 in strategy-2, and 235 in strategy-3. The number needed to screen (NNS) to identify one case was respectively 84, 332, and 425. TB detection was highest among homeless (range: 1,839-2,297 per 100,000 population). The lowest detection was among the MSM and SW. Between 2014 and 2018, 82-94% of all diagnosed TB patients in KPs started TB treatment. Conclusions: The active case finding in KPs increased detection of TB cases in Ukraine, and the majority of diagnosed KPs initiated TB treatment. Centralization of diagnosis reduced the effectiveness of TB screening. Each region in Ukraine should assess the composition and the needs of KPs which will allow for adoption of specific strategies to detect TB among KPs with high TB prevalence.

scholarly journals Mobile community-based active case-finding for tuberculosis among older populations in rural Cambodia

2019 ◽  
Vol 23 (10) ◽  
pp. 1107-1114 ◽  
Author(s):  
O. Camelique ◽  
S. Scholtissen ◽  
J.-P. Dousset ◽  
M. Bonnet ◽  
M. Bastard ◽  
...  
Keyword(s):  
Risk Group ◽  
Treatment Success ◽  
Case Finding ◽  
High Risk Group ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Tb Treatment ◽  
Mobile Community ◽  
Older Populations

OBJECTIVE: To systematically screen older rural populations in Cambodia for tuberculosis (TB) and develop an effective active case-finding (ACF) model for this TB high-risk group.DESIGN: A retrospective study using routinely collected programmatic data on community-based ACF among people aged ≥55 years using TB symptoms and systematic chest radiography (CXR) screening, followed by Xpert® MTB/RIF testing for participants with positive screening results and TB culture for certain Xpert-negative specimens.RESULTS: Of 22 101 participants included in the analysis, 7469 (33.8%) were screening-positive and 5960 (27.0%) underwent Xpert testing. Pulmonary TB was identified in 482 (2.2%) individuals: 288 (1.3%) were bacteriologically confirmed (253 using Xpert, 35 using culture) and 194 (0.9%) were clinically diagnosed. Eighty-seven people needed to be screened in order to diagnose one Xpert-positive case. Among the Xpert-positive cases, only 31.6% (80/253) reported cough ≥2 weeks, and 39.9% (101/253) were asymptomatic but had a CXR suggestive of active TB. Treatment uptake was 97.3% (469/482), and treatment success was 88.0% (424/482).CONCLUSIONS: Community-based ACF was effective in detecting and successfully treating older TB patients, most of whom might otherwise have remained undiagnosed. Mobile CXR appears to be crucial in identifying a high number of asymptomatic, bacteriologically confirmed cases.

scholarly journals Comparison of yield and relative costs of different screening algorithms for tuberculosis in active case-finding: a cross-section study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Zhao ◽  
Canyou Zhang ◽  
Chongguang Yang ◽  
Yinyin Xia ◽  
Jin Xing ◽  
...  
Keyword(s):  
Case Finding ◽  
Active Case Finding ◽  
Face To Face ◽  
Active Case ◽  
Symptom Screening ◽  
Significant Difference ◽  
National Tuberculosis ◽  
Study Population ◽  
The Difference ◽  
The Cost

Abstract Background Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China. Methods The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms. Results Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93–0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96–1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3. Conclusions Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

scholarly journals Are we missing ‘previously treated’ smear-positive pulmonary tuberculosis under programme settings in India? A cross-sectional study

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 338
Author(s):  
Hemant Deepak Shewade ◽  
Vivek Gupta ◽  
Srinath Satyanarayana ◽  
Atul Kharate ◽  
Lakshmi Murali ◽  
...  
Keyword(s):  
Vulnerable Populations ◽  
Past History ◽  
National Level ◽  
Previous History ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Treatment ◽  
History Of ◽  
Previously Treated

Background: In 2007, a field observation from India reported 11% misclassification among ‘new’ patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment. Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as ‘new’ had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of ‘previously treated’ patients among all registered patients treated under the programme at national level.

scholarly journals Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed-methods Study on Outcomes and Implementation Challenges

2019 ◽  
Author(s):  
Abhijit Dey ◽  
Pruthu Thekkur ◽  
Ayan Ghosh ◽  
Tanusree Dasgupta ◽  
Soumyajyoti Bandopadhyay ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Case Finding ◽  
Health Facilities ◽  
Mixed Methods Study ◽  
Attrition Rate ◽  
Active Case Finding ◽  
Identification Rate ◽  
Active Case ◽  
Number Needed To Screen ◽  
Wage Loss

Background: Active case finding for TB was implemented in selected sixty high TB burden wards of Kolkata, India. Community volunteers called TOUCH agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the &lsquo;care cascade&rsquo; of PTBPs identified during July to December, 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. Methods: An explanatory mixed methods study with quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Results: Of the 3, 86,242 individuals enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%) and the number needed to screen for one TB was 2,183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage loss for attending health facilities and substance abuse among PTBPs. Conclusion: The yield of ACF was suboptimal with low PTBP identification rate and high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

scholarly journals Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges

2019 ◽  
Vol 4 (4) ◽  
pp. 134 ◽  
Author(s):  
Abhijit Dey ◽  
Pruthu Thekkur ◽  
Ayan Ghosh ◽  
Tanusree Dasgupta ◽  
Soumyajyoti Bandopadhyay ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Case Finding ◽  
Health Facilities ◽  
Mixed Methods Study ◽  
Attrition Rate ◽  
Active Case Finding ◽  
Identification Rate ◽  
Implementation Challenges ◽  
Active Case ◽  
Number Needed To Screen

Active case finding (ACF) for tuberculosis (TB) was implemented in 60 selected high TB burden wards of Kolkata, India. Community volunteers called TOUCH (Targeted Outreach for Upliftment of Community Health) agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the “care cascade” of PTBPs that were identified during July to December 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. An explanatory mixed-methods study with a quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Of the 3,86242 individuals that were enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited a referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%). The number needed to screen for one TB patient was 2183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage losses for attending health facilities, and substance abuse among PTBPs. The yield of ACF was suboptimal with low PTBP identification rate and a high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

scholarly journals Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12690
Author(s):  
Alvin Kuo Jing Teo ◽  
Kiesha Prem ◽  
Yi Wang ◽  
Tripti Pande ◽  
Marina Smelyanskaya ◽  
...  
Keyword(s):  
Experimental Study ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Case Finding ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Number Needed To Screen ◽  
Life Years ◽  
Quasi Experimental

This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.

scholarly journals Are we missing ‘previously treated’ smear-positive pulmonary tuberculosis under programme settings in India? A cross-sectional study

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 338
Author(s):  
Hemant Deepak Shewade ◽  
Vivek Gupta ◽  
Srinath Satyanarayana ◽  
Atul Kharate ◽  
Lakshmi Murali ◽  
...  
Keyword(s):  
Vulnerable Populations ◽  
Past History ◽  
National Level ◽  
Previous History ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Treatment ◽  
History Of ◽  
Previously Treated

Background: In 2007, a field observation from India reported 11% misclassification among ‘new’ patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment for at least one month (henceforth called ‘misclassification’). Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as ‘new’ had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of ‘previously treated’ patients among all registered patients treated under the programme at national level.

scholarly journals The Presence of Cough and Tuberculosis: Active Case Finding Outcomes in the Philippines

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Siwon Lee ◽  
Lincoln Lau ◽  
Krisha Lim ◽  
Jansel Ferma ◽  
Warren Dodd ◽  
...  
Keyword(s):  
Low Income ◽  
Physical Symptoms ◽  
The Philippines ◽  
Case Finding ◽  
Health Staff ◽  
Active Case Finding ◽  
Multilevel Regression ◽  
Active Case ◽  
Symptom Screening ◽  
Multilevel Regression Model

The results of a tuberculosis (TB) active case finding (ACF) program, implemented by International Care Ministries (ICM) in the Philippines, were examined to understand how the presence of physical symptoms might influence ACF outcomes among extreme low-income Filipinos. ICM health staff implemented symptom screening in villages and suspected cases were referred to the closest rural health unit (RHU) for TB testing. ACF was carried out in Mindanao and the Visayas, across 16 different provinces. All participants were interviewed pre/postprogram, and screening outcomes were collected. A multilevel regression model was constructed to explore the effect of factors on the likelihood of getting tested. A total of 4635 individuals were screened; 1290 (27.8%) were symptom positive and referred. From those referred, 336 (7.2%) were tested for TB and 53 (1.1%) were TB positive. “Cough for more than two weeks” was associated with a 1.09 (95% CI 1.01, 1.15) times increase in likelihood of getting tested. The finding that the presence of cough is associated with higher rate of testing suggests that individuals in these settings might not know or believe that the lack of cough does not equate to lack of TB infection. While technologies and screening algorithms give us the ability to refine the ‘supply’ side of the TB screening, addressing the knowledge gap should improve ‘demand’.

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