Performance of algorithms for tuberculosis active case finding in underserved high-prevalence settings in Cambodia: a cross-sectional study

Abstract Background: In the field of tuberculosis (TB), Community Healthcare Workers (CHWs) have been engaged for advocacy, case detection, and patient support in a wide range of settings. Estimates predict large-sale shortfalls of healthcare workers in low- and middle-income settings by 2030 and strategies are needed to optimize the health workforce to achieve universal availability and accessibility of healthcare. In 2018, the World Health Organization (WHO) published guidelines on best practices for CHW engagement, and identified remaining knowledge gaps. Stop TB Partnership’s TB REACH initiative has supported interventions using CHWs to deliver TB care in over 30 countries, and utilized the same primary indicator to measure project impact at the population-level for all TB active case finding projects, which makes the results comparable across multiple settings. This study compiled 10 years of implementation data from the initiative’s grantee network to begin to address key knowledge gaps in CHW networks.Methods: We conducted a cross-sectional study analyzing the TB REACH data repository (n=123) and primary survey responses (n=50) of project implementers. We designed a survey based on WHO guidelines to understand projects’ practices on CHW recruitment, training, activities, supervision, compensation, and sustainability. We segmented projects by TB notification impact and fitted linear random-effect regression models to identify practices associated with higher changes in notifications. Results: Most projects employed CHWs for advocacy alongside case finding and holding activities. Model characteristics associated with higher project impact included incorporating e-learning in training and having the prospect of CHWs continuing their responsibilities at the close of a project. Factors that trended towards being associated with higher impact were community-based training, differentiated contracts, and non-monetary incentives.Conclusion: In line with WHO guidelines, our findings emphasize that successful implementation approaches provide CHWs with comprehensive training, continuous supervision, fair compensation, and are integrated within the existing primary healthcare system. However, we encountered a great degree of heterogeneity in CHW engagement models, resulting in few practices clearly associated with higher notifications.

Download Full-text

What Makes Community Health Worker Models for Tuberculosis Active Case Finding Work? A Cross-Sectional Study of TB REACH Projects to Identify Success Factors for Increasing Case Notifications

10.21203/rs.3.rs-850489/v2 ◽

2021 ◽

Author(s):

Thu A. Dam ◽

Rachel Forse ◽

Phuong M.T. Tran ◽

Luan N.Q. Vo ◽

Andrew J. Codlin ◽

...

Keyword(s):

Healthcare Workers ◽

Cross Sectional Study ◽

Case Finding ◽

Active Case Finding ◽

Who Guidelines ◽

Sectional Study ◽

Knowledge Gaps ◽

Cross Sectional ◽

Project Impact ◽

Active Case

Abstract Background In the field of tuberculosis (TB), Community Healthcare Workers (CHWs) have been engaged for advocacy, case detection, and patient support in a wide range of settings. Estimates predict large-sale shortfalls of healthcare workers in low- and middle-income settings by 2030 and strategies are needed to optimize the health workforce to achieve universal availability and accessibility of healthcare. In 2018, the World Health Organization (WHO) published guidelines on best practices for CHW engagement, and identified remaining knowledge gaps. Stop TB Partnership’s TB REACH initiative has supported interventions using CHWs to deliver TB care in over 30 countries, and utilized the same primary indicator to measure project impact at the population-level for all TB active case finding projects, which makes the results comparable across multiple settings. This study compiled 10 years of implementation data from the initiative’s grantee network to begin to address key knowledge gaps in CHW networks. Methods We conducted a cross-sectional study analyzing the TB REACH data repository (n=123) and primary survey responses (n=50) of project implementers. We designed a survey based on WHO guidelines to understand projects’ practices on CHW recruitment, training, activities, supervision, compensation, and sustainability. We segmented projects by TB notification impact and fitted linear random-effect regression models to identify practices associated with higher changes in notifications. Results Most projects employed CHWs for advocacy alongside case finding and holding activities. Model characteristics associated with higher project impact included incorporating e-learning in training and having the prospect of CHWs continuing their responsibilities at the close of a project. Factors that trended towards being associated with higher impact were community-based training, differentiated contracts, and non-monetary incentives. Conclusion In line with WHO guidelines, our findings emphasize that successful implementation approaches provide CHWs with comprehensive training, continuous supervision, fair compensation, and are integrated within the existing primary healthcare system. However, we encountered a great degree of heterogeneity in CHW engagement models, resulting in few practices clearly associated with higher notifications.

Download Full-text

Comparative Yield of Tuberculosis during Active Case Finding Using GeneXpert or Smear Microscopy for Diagnostic Testing in Nepal: A Cross-Sectional Study

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020050 ◽

2021 ◽

Vol 6 (2) ◽

pp. 50

Author(s):

Suman Chandra Gurung ◽

Kritika Dixit ◽

Bhola Rai ◽

Raghu Dhital ◽

Puskar Raj Paudel ◽

...

Keyword(s):

Diagnostic Testing ◽

Scale Up ◽

Cross Sectional Study ◽

Case Finding ◽

Smear Microscopy ◽

Active Case Finding ◽

Community Based ◽

Cross Sectional ◽

Active Case ◽

And Control

This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening of social contacts of known index cases, TB camps in remote areas, and screening for hospital out-patient department (OPD) attendees. Symptomatic individuals were then tested using smear microscopy or GeneXpert MTB/RIF as first diagnostic test. Yield rates were compared for each intervention and diagnostic method. We evaluated additional cases notified from ACF interventions by comparing case notifications of the intervention and control districts using standard TB REACH methodology. The project identified 1092 TB cases. The highest yield was obtained from OPD screening at hospitals (n = 566/1092; 52%). The proportion of positive tests using GeneXpert (5.5%, n = 859/15,637) was significantly higher than from microscopy testing 2% (n = 120/6309). (OR = 1.4; 95%CI = 1.12–1.72; p = 0.0026). The project achieved 29% additionality in case notifications in the intervention districts demonstrating that GeneXpert achieved substantially higher case-finding yields. Therefore, to increase national case notification for TB, Nepal should integrate OPD screening using GeneXpert testing in every district hospital and scale up of community-based ACF of TB patient contacts nationally.

Download Full-text

Active case finding: community health workers' activity related to tuberculosis control in a large city, brazil

Texto & Contexto - Enfermagem ◽

10.1590/0104-07072014001600012 ◽

2014 ◽

Vol 23 (2) ◽

pp. 261-269 ◽

Cited By ~ 4

Author(s):

Beatriz Estuque Scatolin ◽

Erika Simone Galvão Pinto ◽

Ricardo Alexandre Arcêncio ◽

Rubia Laine de Paula Andrade ◽

Anneliese Domingues Wysocki ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Large City ◽

Secondary Data ◽

Cross Sectional Study ◽

Case Finding ◽

Active Case Finding ◽

Cross Sectional ◽

Active Case

This study analyzed the Community Health Workers' activity in active case finding in Ribeirão Preto-SP. Cross sectional study, conducted in 2009-2010, with the use of a structured form, which was applied to 105 Community Health Workers and research of secondary data. Indicators were created based on the variable means that used the Likert scale for the answers, being dissatisfactory (scores 1 and 2), regular (3) and satisfactory (4 and 5). Deficiencies in the activity of the Community Workers in the active case finding were identified (mean=3.0), in the discussion with the community about the tuberculosis (mean=1.5) and in the establishment of partnership in the region for the active case finding (mean=1.9). Only 6% of the expected respiratory symptoms in the areas where the units of the participants are located were examined. The results reinforced the need for nursing supervision, a new work logic, with advances in the intersectional articulation, aimed at increasing the detection of tuberculosis cases.

Download Full-text

Prevalence of patients with respiratory symptoms through active case finding and diagnosis of pulmonary tuberculosis among prisoners and related predictors in a jail in the city of Carapicuíba, Brazil

Revista Brasileira de Epidemiologia ◽

10.1590/s1415-790x2010000400009 ◽

2010 ◽

Vol 13 (4) ◽

pp. 641-650 ◽

Cited By ~ 8

Author(s):

Amadeu A. Vieira ◽

Sandra A. Ribeiro ◽

Ana M. de Siqueira ◽

Vera M. N. Galesi ◽

Laedi A. R. dos Santos ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Respiratory Symptoms ◽

Demographic Data ◽

Cross Sectional Study ◽

Case Finding ◽

Active Case Finding ◽

Cross Sectional ◽

Active Case ◽

Alcohol And Drug Abuse ◽

Poor Ventilation

BACKGROUND: Prisons offer a fertile setting for the transmission of tuberculosis due to the presence of many classic risk factors for both infection and disease: overcrowding, poor ventilation, and little sunlight. Prisoners are often malnourished and have poor hygiene and are more likely to have a background of alcohol and drug abuse. OBJECTIVES: To determine the prevalence of prisoners with respiratory symptoms and pulmonary tuberculosis (PTB) through active case finding in a prisoner population of the county jail of Carapicuíba, and to study possible related variables. METHODS: This was a cross-sectional study, and respiratory symptomatic individuals (RSI) were detected through active case finding. Socio-demographic data were collected from inmates' judicial history using a specific questionnaire. The RSI provided sputum specimens for detection of acid fast bacilli and culture for mycobacterium identification. RESULTS: Among the 397 prisoners studied, 154 reported respiratory symptoms for more than three weeks, and were considered RSI; the variables associated with RSI were: having already been tried and incarcerated for more than six months and seven were diagnosed as PTB (1,763 cases/ 100,000 inhabitants). CONCLUSIONS: The prevalence of RSI and PTB cases were respectively 39 and 35 times greater than the general population.

Download Full-text

HIGH PREVALENCE OF MALNUTRITON AND WORM INFECTION AMONG VAN KIEU AND PAKOH CHILDREN AGED 12-36 MONTHS IN DAKRONG DISTRICT, QUANG TRI PROVINCE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.5.16 ◽

2012 ◽

pp. 129-134

Author(s):

Thi Lan Tran ◽

Thi Huong Le ◽

Xuan Ninh Nguyen

Keyword(s):

Cross Sectional Study ◽

Age Group ◽

Infection Status ◽

Sectional Study ◽

Group Recommendation ◽

Related Factors ◽

Normal Children ◽

Cross Sectional ◽

High Prevalence ◽

Very High

Objectives: Assess the nutritional status, worm infection status and some related factors among children aged 12-36 months of Dakrong district, Quang Tri province. Subject and method: A cross sectional study was carried out in 2010, in 680 children aged 12-36 months in 4 communes of Dakrong district, Quang Tri province. Results: The malnutrition rate was 55.0% for underweight, 66.5% for stunting and 16.2% for wasting. The prevalence of malnutrition increases by age group. The prevalence of worm infection was 31.6%, the highest prevalence was belong to Ascaris infection (24.6%), followed by Hookworm and Trichuris (6.5% and 6.2%, respectively). The prevalence of worm infection among children under two is very high (27.0%). The prevalence of worm infection was distributed quite equally between the malnutrition children group and normal children group. Recommendation: Early deworming forchildren from 12 months should be considered as important strategy against the malnutrition of children in Dakrong district, Quang Tri province

Download Full-text

Prevalence of urogenital, anal, and pharyngeal infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium: a cross-sectional study in Reunion island

BMC Infectious Diseases ◽

10.1186/s12879-021-05801-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

A. Calas ◽

N. Zemali ◽

G. Camuset ◽

J. Jaubert ◽

R. Manaquin ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Mycoplasma Genitalium ◽

Cross Sectional Study ◽

Sectional Study ◽

Transmitted Infection ◽

Cross Sectional ◽

Sexually Transmitted ◽

Urogenital Infection ◽

High Prevalence

Abstract Background Recommendations for sexually transmitted infection (STI) screening vary significantly across countries. This study evaluated the prevalence of urogenital and extragenital infections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) in patients visiting a French STI clinic in the Indian Ocean region to determine whether current STI screening practices should be updated. Methods This cross-sectional study examined all patients who visited the STI clinic between 2014 and 2015. Triplex polymerase chain reaction screening for CT, NG, and MG was performed on urine, vaginal, pharyngeal, and anal specimens (FTD Urethritis Basic Kit, Fast Track Diagnostics, Luxembourg). Results Of the 851 patients enrolled in the study, 367 were women (367/851, 43.2%) and 484 were men (484/851, 56.0%). Overall, 826 urogenital specimens (826/851, 97.1%), 606 pharyngeal specimens (606/851, 71.2%), and 127 anal specimens (127/851, 14.9%) were taken from enrolled patients. The prevalence of urogenital CT and MG was high in women ≤25 years (19/186, 10.21%; 5/186, 2.69%) and in men who have sex with women ≤30 years (16/212, 7.54%; 5/212, 2.36%). Among patients with urogenital CT infection, 13.7% (7/51) had urethritis. All patients with urogenital MG infection were asymptomatic. Men who have sex with men had a high prevalence of pharyngeal CT (2/45, 4.44%) and NG (3/44, 6.81%) and a high prevalence of anal CT (2/27, 7.41%), NG (2/27, 7.40%), and MG (1/27, 3.70%). After excluding patients with concomitant urogenital infection, extragenital infections with at least 1 of the 3 pathogens were found in 20 swabs (20/91, 21.9%) taken from 16 patients (16/81, 19.7%), all of them asymptomatic. Conclusions Routine multisite screening for CT, NG, and MG should be performed to mitigate the transmission of STIs in high-risk sexually active populations.

Download Full-text