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 The Use of Xpert MTB/Rif for Active Case Finding among TB Contacts in North West Province, South Africa

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Limakatso Lebina ◽  
Nigel Fuller ◽  
Tolu Osoba ◽  
Lesley Scott ◽  
Katlego Motlhaoleng ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Turnaround Time ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
North West ◽  
Active Case ◽  
Household Contacts ◽  
Significant Difference ◽  
Diagnosis Rate

Introduction.Tuberculosis is a major cause of morbidity and mortality especially in high HIV burden settings. Active case finding is one strategy to potentially reduce TB disease burden. Xpert MTB/Rif has recently been recommended for diagnosis of TB.Methods.Pragmatic randomized trial to compare diagnosis rate and turnaround time for laboratory testing for Xpert MTB/Rif with TB microscopy and culture in household contacts of patients recently diagnosed with TB.Results.2464 household contacts enrolled into the study from 768 active TB index cases. 1068 (44%) were unable to give sputum, but 24 of these were already on TB treatment. 863 (53%) participants sputum samples were tested with smear and culture and 2.7% (23/863; CI: 1.62–3.78) were diagnosed with active TB. Xpert MTB/Rif was used in 515 (21%) participants; active TB was diagnosed in 1.6% (8/515; CI: 0.52–2.68).Discussion and Conclusions.Additional 31 cases were diagnosed with contact tracing of household members. When Xpert MTB/Rif is compared with culture, there is no significant difference in diagnostic yield.

scholarly journals The Impact of Funding on Childhood TB Case Detection in Pakistan

2019 ◽  
Vol 4 (4) ◽  
pp. 146 ◽  
Author(s):  
Amyn A. Malik ◽  
Hamidah Hussain ◽  
Jacob Creswell ◽  
Sara Siddiqui ◽  
Junaid F. Ahmed ◽  
...  
Keyword(s):  
Case Finding ◽  
Active Case Finding ◽  
Average Case ◽  
Active Case ◽  
Implementation Period ◽  
Childhood Tb ◽  
Continuous Stream ◽  
The Cost ◽  
The Impact ◽  
Case Notification

This study is a review of routine programmatically collected data to describe the 5-year trend in childhood case notification in Jamshoro district, Pakistan from January 2013 to June 2018 and review of financial data for the two active case finding projects implemented during this period. The average case notification in the district was 86 per quarter before the start of active case finding project in October 2014. The average case notification rose to 322 per quarter during the implementation period (October 2014 to March 2016) and plateaued at 245 per quarter during the post-implementation period (April 2016 to June 2018). In a specialized chest center located in the district, where active case finding was re-introduced during the post implementation period (October 2016), the average case notification was 218 per quarter in the implementation period and 172 per quarter in the post implementation period. In the rest of the district, the average case notification was 160 per quarter in the implementation period and 78 during the post implementation period. The cost per additional child with TB found ranged from USD 28 to USD 42 during the interventions. A continuous stream of resources is necessary to sustain high notifications of childhood TB.

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 The cost-effectiveness of incentive-based active case finding for tuberculosis (TB) control in the private sector Karachi, Pakistan

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hamidah Hussain ◽  
Amani Thomas Mori ◽  
Aamir J. Khan ◽  
Saira Khowaja ◽  
Jacob Creswell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Private Sector ◽  
Health Sector ◽  
Cost Effective ◽  
Case Finding ◽  
Active Case Finding ◽  
Tree Model ◽  
Active Case ◽  
Tb Control ◽  
The Cost

Abstract Background In Asia, over 50% of patients with symptoms of tuberculosis (TB) access health care from private providers. These patients are usually not notified to the National TB Control Programs, which contributes to low notification rates in many countries. Methods From January 1, 2011 to December 31, 2012, Karachi’s Indus Hospital - a private sector partner to the National TB Programme - engaged 80 private family clinics in its catchment area in active case finding using health worker incentives to increase notification of TB disease. The costs incurred were estimated from the perspective of patients, health facility and the program providing TB services. A Markov decision tree model was developed to calculate the cost-effectiveness of the active case finding as compared to case detection through the routine passive TB centers. Pakistan has a large private health sector, which can be mobilized for TB screening using an incentivized active case finding strategy. Currently, TB screening is largely performed in specialist public TB centers through passive case finding. Active and passive case finding strategies are assumed to operate independently from each other. Results The incentive-based active case finding program costed USD 223 per patient treated. In contrast, the center based non-incentive arm was 23.4% cheaper, costing USD 171 per patient treated. Cost-effectiveness analysis showed that the incentive-based active case finding program was more effective and less expensive per DALY averted when compared to the baseline passive case finding as it averts an additional 0.01966 DALYs and saved 15.74 US$ per patient treated. Conclusion Both screening strategies appear to be cost-effective in an urban Pakistan context. Incentive driven active case findings of TB in the private sector costs less and averts more DALYs per health seeker than passive case finding, when both alternatives are compared to a common baseline situation of no screening.

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’.

scholarly journals Correction to: The cost-effectiveness of incentive-based active case finding for tuberculosis (TB) control in the private sector Karachi, Pakistan

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hamidah Hussain ◽  
Amani Thomas Mori ◽  
Aamir J. Khan ◽  
Saira Khowaja ◽  
Jacob Creswell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Private Sector ◽  
Case Finding ◽  
Active Case Finding ◽  
Original Publication ◽  
Active Case ◽  
Tb Control ◽  
The Cost

In the original publication of this article [1], an author’s name needs to be revised from Jacob Creswel to Jacob Creswell.

scholarly journals Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo

2020 ◽  
Vol 14 (12) ◽  
pp. e0008832
Author(s):  
Rian Snijders ◽  
Alain Fukinsia ◽  
Yves Claeys ◽  
Alain Mpanya ◽  
Epco Hasker ◽  
...  
Keyword(s):  
Lower Cost ◽  
Democratic Republic ◽  
Capillary Tube ◽  
Case Finding ◽  
New Method ◽  
Active Case Finding ◽  
Active Screening ◽  
Active Case ◽  
Republic Of The Congo ◽  
The Cost

Background Human African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease targeted for eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study compares the cost of two active case-finding approaches, namely the traditional mobile teams and mini mobile teams, in the two health districts of the Democratic Republic of the Congo. Methods The financial and economic costs of both approaches were estimated from a health care provider perspective. Cost and operational data were collected for 12 months for 1 traditional team and 3 mini teams. The cost per person screened and diagnosed was calculated and univariate sensitivity analysis was conducted to identify the main cost drivers. Results During the study period in total 264,630 people were screened, and 23 HAT cases detected. The cost per person screened was lower for a mini team than for a traditional team in the study setting (US$1.86 versus US$2.08). A comparable result was found in a scenario analysis, assuming both teams would operate in a similar setting, with the cost per person screened by a mini team 15% lower than the cost per person screened by a traditional team (1.86 $ vs 2.14$). The main explanations for this lower cost are that mini teams work with fewer human resources, cheaper means of transportation and do not perform the Capillary Tube Centrifugation test or card agglutination test dilutions. Discussion Active HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active case-finding. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.

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