scholarly journals Identifying TB hotspots through mobile X-rays in Karachi, Pakistan: spatial analysis of data from an active case-finding program

2021 ◽  
Author(s):  
Syed Mohammad Asad Zaidi ◽  
Wafa Zehra Jamal ◽  
Christina Mergenthaler ◽  
Kiran Sohail Azeemi ◽  
Nick Van Den Berge ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Spatial Autocorrelation ◽  
Case Finding ◽  
World Health ◽  
Moran’S I ◽  
X Rays ◽  
Active Case Finding ◽  
Moran's I ◽  
X Ray ◽  
Active Case

Abstract IntroductionTuberculosis (TB) is the leading cause of avoidable deaths from an infectious disease globally and a large of number of people who develop TB each year remain undiagnosed. Active case-finding has been recommended by the World Health Organization to bridge the case-detection gap for TB in high burden countries. However, concerns remain regarding their yield and cost-effectiveness. MethodsData from mobile chest X-ray (CXR) supported active case-finding community camps conducted in Karachi, Pakistan from July 2017- March 2020 was retrospectively analyzed. After a CXR screening supported by computer-aided detection, those with presumptive TB were counselled to submit a sputum sample for Xpert MTB/RIF testing. Frequency analysis was carried out at the camp-level and outcomes of interest for the spatial analyses were mycobacterium TB positivity (MTB+) and X-ray abnormality ratios. The Moran’s I statistic was used to test for spatial autocorrelation for MTB+ and abnormal X-rays within Union Councils (UCs) in Karachi. Local Indicators of Spatial Autocorrelation analyses were performed for UCs within Karachi. Point-pattern analyses were carried out utilizing GPS coordinates recorded at the camp sites and were analyzed for spatial autocorrelation using Getis Ord Star tests.ResultsA total of 1,161 (78.1%) camps yielded no MTB+ cases, 246 (16.5%) camps yielded 1 MTB+, 52 (3.5%) camps yielded 2 MTB+ and 27 (1.8%) yielded 3 or more MTB+. A total of 79 (5.3%) camps accounted for 193 (44.0%) of MTB+ cases detected. Statistically significant clustering for MTB positivity (Moran’s I: 0.09) and abnormal chest X-rays (Moran’s I: 0.36) ratios was identified within UCs in Karachi. Clustering of UCs with high MTB positivity were identified in Karachi West district. Clusters of camp locations with high MTB+ ratios were identified in Karachi South and Karachi West districts and in several locations in the north and eastern peripheries of the city. ConclusionStatistically significant spatial variation was identified in yield of bacteriologically positive TB cases and in abnormal CXR through active case-finding in Karachi. Cost-effectiveness of active case-finding programs can be improved by identifying and focusing interventions in hotspots and avoiding locations with no known TB cases reported through routine surveillance.

Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding

Infection ◽  
2012 ◽  
Vol 40 (4) ◽  
pp. 389-395 ◽  
Author(s):  
U. Goetsch ◽  
O. K. Bellinger ◽  
K.-L. Buettel ◽  
R. Gottschalk
Keyword(s):  
Drug Users ◽  
Homeless Persons ◽  
Case Finding ◽  
Active Case Finding ◽  
X Ray ◽  
Active Case

Utilizing chest X-ray based active case finding approach for early tuberculosis case detection in Pakistan

2019 ◽  
Author(s):  
Shifa Habib ◽  
Kiran Azeemi ◽  
S. M. Asad Zaidi ◽  
Wafa Jamal ◽  
Talha Kazmi ◽  
...  
Keyword(s):  
Case Finding ◽  
Case Detection ◽  
Active Case Finding ◽  
Tuberculosis Case ◽  
X Ray ◽  
Active Case ◽  
Chest X Ray

scholarly journals The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Suman Chandra Gurung ◽  
Kritika Dixit ◽  
Bhola Rai ◽  
Maxine Caws ◽  
Puskar Raj Paudel ◽  
...  
Keyword(s):  
Social Protection ◽  
Case Finding ◽  
World Health ◽  
Active Case Finding ◽  
Annual Household Income ◽  
Chi Square ◽  
Active Case ◽  
Pre Treatment ◽  
Health Organization

Abstract Background The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. Methods The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. Results Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P <  0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. Conclusions ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.

scholarly journals Chest x-ray findings in tuberculosis patients identified by passive and active case finding: A retrospective study

2019 ◽  
Vol 14 ◽  
pp. 26-30 ◽  
Author(s):  
Ema Rastoder ◽  
Saher Burhan Shaker ◽  
Matiullah Naqibullah ◽  
Mathilde Marie Winkler Wille ◽  
Mette Lund ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Case Finding ◽  
Active Case Finding ◽  
Tuberculosis Patients ◽  
X Ray ◽  
Active Case ◽  
Chest X Ray

scholarly journals Cost-Effectiveness of a Tuberculosis Active Case Finding Program Targeting Household and Neighborhood Contacts in Cambodia

2014 ◽  
Vol 90 (5) ◽  
pp. 866-872 ◽  
Author(s):  
Rajendra P. Yadav ◽  
Nobuyuki Nishikiori ◽  
Peou Satha ◽  
Mao T. Eang ◽  
Yoel Lubell
Keyword(s):  
Cost Effectiveness ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case

scholarly journals Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru

2017 ◽  
Vol 145 (6) ◽  
pp. 1107-1117 ◽  
Author(s):  
L. SHAH ◽  
M. ROJAS ◽  
O. MORI ◽  
C. ZAMUDIO ◽  
J. S. KAUFMAN ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Test ◽  
Cost Effective ◽  
Case Finding ◽  
Self Report ◽  
Urban Setting ◽  
Active Case Finding ◽  
Active Case ◽  
Household Contacts ◽  
Life Years

SUMMARYWe compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.

scholarly journals Active detection of tuberculosis: tackling the problem head on in the remote area of Andaman and Nicobar Islands

2019 ◽  
Vol 6 (8) ◽  
pp. 3314
Author(s):  
Samarendra Prasanna Burma ◽  
Gunda Jahnavi ◽  
Pappachen Lal ◽  
Pandurang V. Thatkar
Keyword(s):  
Case Finding ◽  
Nucleic Acid Amplification ◽  
Sputum Smear ◽  
Active Case Finding ◽  
Community Based ◽  
Cross Sectional ◽  
X Ray ◽  
Active Case ◽  
Sputum Microscopy ◽  
Team Activity

Background: Community based active case finding for tuberculosis (TB) is an essential step in the fight forward for eliminating TB. One of the steps in targeting TB intervention is early diagnosis and treatment of patients by reducing the reservoir of infection in the community. Active case finding (ACF) targeting the entire population by house to house survey was done in Nicobar district of these islands.Methods: A community-based, cross-sectional, descriptive study was conducted with the trained mobile teams from 17.07.2017 to 31.07.2017 in the Nicobar District. The algorithm of the case detection included screening patients by symptoms, then by sputum microscopy for confirmation. X-ray was done in patients who were symptomatic but sputum negative. If both smear and chest X-ray results were negative but still symptomatic, then cartridge-based nucleic acid amplification test (CBNAAT) was done.Results: A total population of 18526 was mapped of which 14784 (79.8) could be screened. A total of 209 people were identified by the mobile teams with symptoms who were examined by sputum microscopy. Among them 7 cases were identified to be sputum smear positive, 2 X-ray positive and 2 were diagnosed by CBNAAT.Conclusions: This study shows that the active case finding method is feasible and acceptable by the community. The results obtained are encouraging for the implementation of ACF through mobile team activity in all these islands in order to meet the target of WHO’s End TB Strategy.

Sign in / Sign up

Export Citation Format

Share Document