A yield and cost comparison of tuberculosis contact investigation and intensified case finding in Uganda

ABSTRACTIntroductionResource constraints in LMICs limit TB contact investigation despite evidence its benefits outweigh costs, with increased efficiency when compared with intensified case finding (ICF). However, there is limited data on the yield and cost per TB case identified in low resource-settings. We compared the yield and cost per TB case identified for ICF and TB-CI in Uganda.MethodsA retrospective cohort study based on data from 12 Ugandan hospitals was done between April and September 2017. Two methods of TB case finding (i.e. ICF and TB-CI) were used. Regarding ICF, patients either self-reported their signs and symptoms or were prompted by health care workers, and those suspected to have TB were requested to produce a sputum sample. On the other hand, TB-CI was done by home-visiting and screening contacts of TB patients for TB; with those found with signs and symptoms requested to produce sputum samples for examination. TB yield was defined as the ratio of diagnoses to tests, and this was computed per method of diagnosis. The costs per TB case identified (medical, personnel, transportation and training) for each diagnosis method were computed using the activity-based approach, from the health care perspective. Cost data were analyzed using Windows Excel.Results454 index clients’ cases and 2,707 of their household contacts were investigated. Thirty-one per cent of contacts (840/2707) were found to be presumptive TB cases. A total of 7,685 tests were done, 6,967 for ICF and 718 for TB-CI. ICF had a yield of 18.62% (1297/6967) at a cost of USD $120.60 to diagnose a case of TB while TB-CI had a yield of 5.29% (38/718) at an average cost of USD $ 877.57 to diagnose a case of TB.ConclusionRegarding case-finding, the yield of TB-CI was four-times lower and seven-times costlier compared to ICF. These findings suggest that ICF can improve TB case detection at a low cost, particularly in high TB prevalent settings.

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Impact of intensified case-finding strategies on childhood TB case registration in Nepal

Public Health Action ◽

10.5588/pha.15.0004 ◽

2015 ◽

Vol 5 (2) ◽

pp. 93-98 ◽

Cited By ~ 9

Author(s):

B. Joshi ◽

P. Chinnakali ◽

A. Shrestha ◽

M. Das ◽

A. M. V. Kumar ◽

...

Keyword(s):

Case Finding ◽

Intensified Case Finding ◽

Childhood Tb

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Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2021.783 ◽

2021 ◽

Vol 16 ◽

Author(s):

Ablo Prudence Wachinou ◽

Serge Ade ◽

Maimouna Ndour Mbaye ◽

Boubacar Bah ◽

Naby Balde ◽

...

Keyword(s):

Diabetes Mellitus ◽

Associated Factors ◽

Close Contact ◽

Case Finding ◽

Sputum Smear ◽

African Countries ◽

Consultation Process ◽

Cross Sectional ◽

Factors Associated ◽

Intensified Case Finding

Background: To determine the prevalence of tuberculosis (TB) and associated factors in persons with diabetes mellitus (DM) in Benin, Guinea and Senegal.Methods: A cross-sectional study was conducted in the largest DM center in each country. Participants systematically underwent clinical screening and chest radiography. Participants who were symptomatic or with abnormal radiography underwent bacteriological investigations (sputum smear, Xpert MTB/RIF and culture) on sputum. Participants with no TB at enrolment were re-examined for TB six months later. Logistic regression was performed to identify factors associated with TB.Results: There were 5870 DM patients: 1881 (32.0%) in Benin, 1912 (32.6%) in Guinea and 2077 (35.4%) in Senegal. Of these, 114 had bacteriologically-confirmed TB, giving a pooled prevalence of 1.9% (95%CI=1.6-2.3). TB prevalence was 0.5% (95%CI=0.3-1.0), 2.4% (95%CI=1.8-3.2) and 2.8% (95%CI=2.2-3.6), respectively, in Benin, Guinea and Senegal. Factors associated with an increased odds of TB diagnosis were a usual residence in Guinea (aOR=2.62;95%CI=1.19-5.77; p=0.016) or in Senegal (aOR=3.73;95%CI=1.85-7.51; p<0.001), the age group of 35-49 years (aOR=2.30;95%CI=1.11-4.79; p=0.025), underweight (aOR=7.34;95%CI=4.65-11.57; p<0.001) and close contact with a TB case (aOR=2.27;95%CI=1.37-3.76; p=0.002). Obesity was associated with lower odds of TB (aOR=0.20; 95%CI=0.06-0.65; p=0.008).Conclusion: TB is prevalent among DM patients in Benin, Guinea and Senegal and higher than among the general population. The findings support the need for intensified case finding in DM patients in order to ensure systematic early detection of TB during the routine consultation process.

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