Feasibility and Effectiveness of Mobile App for Active Case Finding for Tuberculosis in India

Background: Tuberculosis (TB) is an infectious disease with 2.8 million cases and 480,000 deaths each year in India. The city of Indore alone with a population of 3.5 million had 7,839 identified TB cases in 2017. However, about two to three thousand additional cases remain unidentified per district officials. The unidentified cases lead to an endemic TB and hamper the efforts of organizations such as The Collaborative to Eliminate TB from India (CETI) to reduce the incidence of TB with the method of Active Case Finding (ACF).1 Previously, 1,332 mobile apps attempted to use technology to overcome the challenge of unreported TB patients in Indian slum areas due to the inaccurate, lost, or unhelpful data collected in ACF; yet the existing apps for TB prevention and treatment possessed minimal functionality. Over a period of 3 months, the CETI developed a mobile data collection app to generate a TB diagnostic survey and to collect data from patient registration form. Methods: To study the feasibility and effectiveness of the app, a pilot survey was conducted of 163,496 homes covering a population of 828,020 in the slum areas of Indore and Bhopal. Findings: Between the years of 2018 and 2019, 14,349 pulmonary suspected cases and 4,357 extra pulmonary suspected cases of TB were identified. Among the total of 18,706 cases identified, 7,756 patients (48.1%) had low-grade fever for over 2 weeks, 6,331 patients (39.2%) had persistent cough for more than 2 weeks, 7,693 patients (47.7%) had weight loss, and 251 patients (1.6%) had cough with blood. Interpretation: This pilot experience shows that an app is a useful tool for TB case recording and follow-up in the field. Further training of the health workers, and more widespread availability and ease of use of mobile phones will be necessary.

Download Full-text

Enablers and Challenges in the Implementation of Active Case Findings in a Selected District of Karnataka, South India: A Qualitative Study

Tuberculosis Research and Treatment ◽

10.1155/2020/9746329 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Amrita N. Shamanewadi ◽

Poonam R. Naik ◽

Pruthu Thekkur ◽

Suwarna Madhukumar ◽

Abhay Subhashrao Nirgude ◽

...

Keyword(s):

Health Care ◽

Health System ◽

General Health ◽

South India ◽

Health Workers ◽

Case Finding ◽

Rural District ◽

Health Staff ◽

Active Case Finding ◽

Active Case

Background. Active case finding (ACF) for tuberculosis (TB) is a promising tool to enhance early case detection among marginalized populations. As opposed to passive case finding, it involves systematically searching for TB in individuals who would not spontaneously present for care. The National TB Program (NTP) of India has initiated ACF for TB through the existing general health system since the end of 2017. However, prior to scale-up, there is need for exploring the implementation challenges and solutions to improve the efficiency of this program. Objectives. (1) To explore the enablers and challenges in the implementation of ACF for TB by NTP in the Bengaluru rural district of Karnataka, South India, and (2) to explore the perceived solutions to improve the efficiency of ACF activity. Methods. A qualitative descriptive study was conducted in the Bengaluru rural district during July 2018. In-depth interviews using purposively selected health care providers involved in active case finding (n=9) and presumptive TB patients (n=8) were conducted. Manual content analysis was conducted by two independent researchers to generate categories and themes. Results. The challenges in conduct of ACF were as follows: inadequate training of health care workers, shortage of staff, indifferent attitude of community due to stigma, lack of awareness about TB, illiteracy, inability to convince patients for sputum test, and delay in getting CBNAAT results. The field staff recommended the installation of mobile CBNAAT machine, involvement of general health staff in activity, training of health workers on counseling of patients, and issue of identity cards for community health workers/volunteers so that people recognize them. Conclusion. The health system challenges in conduct of ACF need to be addressed by training the health staff involved in activity and also improving the access to TB diagnostics.

Download Full-text

PELAKSANAAN TUGAS KADER TUBERKULOSIS DI KABUPATEN BADUNG TAHUN 2019

ARCHIVE OF COMMUNITY HEALTH ◽

10.24843/ach.2020.v07.i01.p06 ◽

2020 ◽

Vol 7 (1) ◽

pp. 52

Author(s):

Ni Wayan Emi Liana Anggraeni ◽

Made Pasek Kardiwinata

Keyword(s):

Passive Control ◽

Health Workers ◽

Case Finding ◽

Successful Implementation ◽

Active Case Finding ◽

Cross Sectional ◽

Active Case ◽

Key Word ◽

Complete Treatment ◽

Level Of Knowledge

ABSTRAK Upaya pengendalian secara pasif oleh petugas kesehatan masih belum dapat menekan angka tuberkulosis di Kabupaten Badung. Dibutuhkan adanya kegiatan penemuan kasus secara aktif serta pendampingan pasien selama menjalani pengobatan lengkap yang lebih optimal, tidak hanya dari petugas pemegang program namun juga dibutuhkan peran serta dari masyarakat, salah satunya adalah dengan memanfaatkan tenaga kader. Keberhasilan pelaksanaan tugas kader memiliki peran penting dalam membangun kerja sama dengan petugas kesehatan untuk menekan kejadian tuberkulosis. Tujuan penelitian ini untuk mengetahui pelaksanaan tugas kader TB di Kabupaten Badung tahun 2019. Desain penelitian ini adalah observasional cross-sectional deskriptif. Sampel dalam penelitian ini adalah seluruh kader TB yang ada di Kabupaten Badung berjumlah 50 orang. Data diperoleh dengan teknik wawancara menggunakan kuesioner. Hasil penelitian menunjukkan bahwa pelaksanaan tugas kader TB masih kurang yang disebabkan oleh kurangnya keterlibatan kader TB dalam pendampingan pengobatan. Diantara pelaksanaan tugas yang kurang tersebut, dijumpai temuan bahwa kader TB yang berjenis kelamin laki-laki, memiliki pekerjaan selain sebagai kader TB serta memiliki tingkat pengetahuan baik, cenderung memiliki pelaksanaan tugas yang baik. Disarankan bagi instansi terkait dalam perekrutan kader selanjutnya agar lebih memprioritaskan kader berjenis kelamin laki-laki dikarenakan kebanyakan tugas dari kader TB berada di luar ruangan. Kata Kunci : Pelaksanaan tugas, Kader, TB ABSTRACT Passive control efforts by health workers still cannot reduce the rate of tuberculosis in Badung Regency. Active case-finding activities are needed as well as mentoring patients while undergoing more optimal complete treatment, not only from program officers but also from the community's participation, one of which is to use community TB workers. The successful implementation of work perfomance community TB workers has a very important role in building cooperation with health workers to reduce the incidence of tuberculosis. This study aims to determine the Implementation of Work Perfomance Community TB Workers in Badung Regency 2019. The design of this study was cross-sectional observational descriptive. The sample in this study was that all tuberculosis cadres in Badung Regency gathered 50 people. Data obtained by interview techniques using questionnaires. The results showed that the implementation of TB cadre assignments was still lacking caused by the involvement of TB cadres in treatment assistance. Among the implementation of these lacking tasks, found the finding that TB cadres who are male, have jobs other than as TB cadres and have a good level of knowledge, need to have good implementation tasks. Furthermore, further submissions for male cadres greater than the TB cadre assignments were outdoors. Key Word : Job, cadre, TB

Download Full-text

Active Case Finding for Improved Ebola Virus Disease Case Detection in Nimba County, Liberia, 2014/2015: Lessons Learned

Advances in Public Health ◽

10.1155/2018/6753519 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

E. Namukose ◽

C. Bowah ◽

I. Cole ◽

G. Dahn ◽

P. Nyanzee ◽

...

Keyword(s):

Ebola Virus ◽

Health Workers ◽

Virus Disease ◽

Case Finding ◽

Lessons Learned ◽

Ebola Virus Disease ◽

World Health ◽

Case Detection ◽

Active Case Finding ◽

Active Case

Objectives. Early case detection and isolation of patients infected with highly infectious diseases are crucial in the management and control of epidemics such as Ebola Virus Disease (EVD). In this paper, we share the lessons learned from implementation of active case finding as a strategy for improved EVD case detection in Nimba County, Liberia. Methods. We adopted the World Health Organization (WHO) active surveillance strategy to identify and report suspected EVD cases, follow up contacts of confirmed cases, and report community deaths. We identified, trained, and deployed 1060 Community Health Volunteers (CHVs) in 718 communities in Nimba County. The CHVs were supervised by 142 health workers within their catchment area. The health workers were supervised by the District Health Officers (DHOs). The DHOs reported to the County Health Team (CHT) who provided supportive supervision. Data collection was based on the EVD contact tracing and active case finding forms adopted from WHO. Data analysis was based on epi-weeks. Results. The number of EVD suspected cases increased by more than 75% following the initiation of active case finding. Average duration between symptom onset and case detection reduced from between three and five days to within 24 hours. Collection of oral swabs from dead bodies increased from two to 15 within the first week of active case finding strategy implementation. Reporting of other IDSR priority diseases and conditions also improved. Conclusion. Active case finding strategy in Nimba increased suspected EVD case detection and reduced the duration between onset of symptoms and detection of cases.

Download Full-text

Islands of Tuberculosis Elimination: An Evaluation of Community-Based Active Case Finding in North Sumatra, Indonesia

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5040163 ◽

2020 ◽

Vol 5 (4) ◽

pp. 163

Author(s):

Elvi S. Siahaan ◽

Mirjam I. Bakker ◽

Ratna Pasaribu ◽

Amera Khan ◽

Tripti Pande ◽

...

Keyword(s):

Health Workers ◽

Scale Up ◽

Case Finding ◽

System Support ◽

Active Case Finding ◽

Community Based ◽

Active Case ◽

Hard To Reach Populations ◽

North Sumatra ◽

Positive Effect

Community-based active case finding (ACF) is needed to reach key/vulnerable populations with limited access to tuberculosis (TB) care. Published reports of ACF interventions in Indonesia are scarce. We conducted an evaluation of a multicomponent community-based ACF intervention as it scaled from one district to nine in Nias and mainland North Sumatra. Community and health system support measures including laboratory strengthening, political advocacy, sputum transport, and community awareness were instituted. ACF was conducted in three phases: pilot (18 months, 1 district), intervention (12 months, 4 districts) and scale-up (9 months, 9 districts). The pilot phase identified 215 individuals with bacteriologically positive (B+) TB, representing 42% of B+ TB notifications. The intervention phase yielded 509, representing 54% of B+ notifications and the scale-up phase identified 1345 individuals with B+ TB (56% of notifications). We observed large increases in B+ notifications on Nias, but no overall change on the mainland despite district variation. Overall, community health workers screened 377,304 individuals of whom 1547 tested positive, and 95% were initiated on treatment. Our evaluation shows that multicomponent community-based ACF can reduce the number of people missed by TB programs. Community-based organizations are best placed for accessing and engaging hard to reach populations and providing integrated support which can have a large positive effect on TB notifications.

Download Full-text

Prediagnostic loss to follow-up in an active case finding tuberculosis programme: a mixed-methods study from rural Bihar, India

BMJ Open ◽

10.1136/bmjopen-2019-033706 ◽

2020 ◽

Vol 10 (5) ◽

pp. e033706 ◽

Cited By ~ 3

Author(s):

Tushar Garg ◽

Vivek Gupta ◽

Dyuti Sen ◽

Madhur Verma ◽

Miranda Brouwer ◽

...

Keyword(s):

Mixed Methods ◽

Health System ◽

Health Workers ◽

Case Finding ◽

Diagnostic Evaluation ◽

Active Case Finding ◽

Loss To Follow Up ◽

The Public ◽

Active Case

ObjectiveTo quantify the prediagnostic loss to follow-up (PDLFU) in an active case finding tuberculosis (TB) programme and identify the barriers and enablers in undergoing diagnostic evaluation.DesignExplanatory mixed-methods design.SettingA rural population of 1.02 million in the Samastipur district of Bihar, India.ParticipantsBased on their knowledge of health status of families, community health workers or CHWs (called accredited social health activist or locally) and informal providers referred people to the programme. The field coordinators (FCs) in the programme screened the referrals for TB symptoms to identify presumptive TB cases. CHWs accompanied the presumptive TB patients to free diagnostic evaluation, and a transport allowance was given to the patients. Thereafter, CHWs initiated and supported the treatment of confirmed cases. We included 13 395 community referrals received between January and December 2018. To understand the reasons of the PDLFU, we conducted in-depth interviews with patients who were evaluated (n=3), patients who were not evaluated (n=4) and focus group discussions with the CHWs (n=2) and FCs (n=1).Outcome measuresProportion and characteristics of PDLFU and association of demographic and symptom characteristics with diagnostic evaluation.ResultsA total of 11 146 presumptive TB cases were identified between January and December 2018, out of which 4912 (44.1%) underwent diagnostic evaluation. In addition to the free TB services in the public sector, the key enablers were CHW accompaniment and support. The major barriers identified were misinformation and stigma, deficient family and health provider support, transport challenges and poor services in the public health system.ConclusionFinding the missing cases will require patient-centric diagnostic services and urgent reform in the health system. A community-oriented intervention focusing on stigma, misinformation and patient support will be critical to its success.

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