scholarly journals A Multi-Faceted Approach to Tuberculosis Active Case Finding among Remote Riverine Communities in Southern Nigeria

2021 ◽  
Vol 18 (18) ◽  
pp. 9424
Author(s):  
Andy Samuel Eyo ◽  
Valerie Okon Obot ◽  
Okezie Onyedinachi ◽  
Nathaly Aguilera Vasquez ◽  
Jacob Bigio ◽  
...  
Keyword(s):  
Community Outreach ◽  
Case Finding ◽  
Control Population ◽  
Active Case Finding ◽  
Access To Health Services ◽  
Historical Trends ◽  
Active Case ◽  
Southern Nigeria ◽  
Community Volunteers ◽  
The Impact

Nigeria accounts for 11% of the worldwide gap between estimated and reported individuals with tuberculosis (TB). Hard-to-reach communities on the Southern Nigeria coast experience many difficulties accessing TB services. We implemented an active case finding (ACF) intervention in Akwa Ibom and Cross River states utilizing three approaches: house-to-house/tent-to-tent screening, community outreach and contact investigation. To evaluate the impact, we compared TB notifications in intervention areas to baseline and control population notifications, as well as to expected notifications based on historical trends. We also gathered field notes from discussions with community volunteers who provided insights on their perspectives of the intervention. A total of 509,768 individuals were screened of which 12,247 (2.4%) had TB symptoms and 11,824 (96.5%) were tested. In total, 1015 (8.6%) of those identified as presumptive had confirmed TB—98.2% initiated treatment. Following implementation, TB notifications in intervention areas increased by 112.9% compared to baseline and increased by 138.3% when compared to expected notifications based on historical trends. In contrast, control population notifications increased by 101% and 49.1%, respectively. Community volunteers indicated a preference for community outreach activities. Multi-faceted, community-based interventions in Nigeria’s coastal areas successfully increase TB detection for communities with poor access to health services.

scholarly journals The impact of active case finding among high-risk populations on the decline of tuberculosis incidence

2021 ◽  
Author(s):  
Aleksandra Tomczak ◽  
Dominika Warmjak ◽  
Aneta Wiśniewska
Keyword(s):  
High Risk ◽  
Disease Transmission ◽  
Reproduction Number ◽  
Case Finding ◽  
Transmission Risk ◽  
Active Case Finding ◽  
Disease Dynamics ◽  
Active Screening ◽  
Active Case ◽  
The Impact

Introduction: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. In 2019 the WHO reported approximately 10 million TB cases and 1.4 million deaths worldwide. TB still remains one of the leading causes of death in humans. Brazil is one of 30 countries with the highest TB burden with 96,000 new cases and 6,700 deaths reported in 2019. From 2015 the TB incidence is increasing by 2%–3% annually. It means that TB control programs need to be improved. Aim: Our aim is to show the impact of active case finding of TB cases among a high-risk subpopulation on decline of the incidence in the general population. Material and methods: We use a SIS-type compartmental mathematical model to describe the disease dynamics. We consider the population as a heterogeneous population which differ in disease transmission risk. Using best-fit techniques we compare the actual data with the model. For the fitted parameters we calculate the basic reproduction number and estimate the TB trends for the next few years applying several preventative protocols. Results and discussion: Using numerical simulations we examine the impact of ACF on the disease dynamics. We show that active screening among high risk subpopulations can help to reduce TB spread. We show how the reproduction number and estimated incidence decline depend on the detection rate. Conclusions: Active screening is one of the most effective ways for reducing the spread of disease. However, due to financial constraints, it can only be used to a limited extent. Properly applied detection can limit the spread of the disease while minimizing costs.

scholarly journals Do community-based active case-finding interventions have indirect impacts on wider TB case detection and determinants of subsequent TB testing behaviour? A systematic review

2021 ◽  
Vol 1 (12) ◽  
pp. e0000088
Author(s):  
Helena R. A. Feasey ◽  
Rachael M. Burke ◽  
Marriott Nliwasa ◽  
Lelia H. Chaisson ◽  
Jonathan E. Golub ◽  
...  
Keyword(s):  
Indirect Effect ◽  
Controlled Trial ◽  
Case Finding ◽  
Case Detection ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Attitudes And Practices ◽  
The Impact ◽  
Case Notification

Community-based active case-finding (ACF) may have important impacts on routine TB case-detection and subsequent patient-initiated diagnosis pathways, contributing “indirectly” to infectious diseases prevention and care. We investigated the impact of ACF beyond directly diagnosed patients for TB, using routine case-notification rate (CNR) ratios as a measure of indirect effect. We systematically searched for publications 01-Jan-1980 to 13-Apr-2020 reporting on community-based ACF interventions compared to a comparison group, together with review of linked manuscripts reporting knowledge, attitudes, and practices (KAP) outcomes or qualitative data on TB testing behaviour. We calculated CNR ratios of routine case-notifications (i.e. excluding cases identified directly through ACF) and compared proxy behavioural outcomes for both ACF and comparator communities. Full text manuscripts from 988 of 23,883 abstracts were screened for inclusion; 36 were eligible. Of these, 12 reported routine notification rates separately from ACF intervention-attributed rates, and one reported any proxy behavioural outcomes. Two further studies were identified from screening 1121 abstracts for linked KAP/qualitative manuscripts. 8/12 case-notification studies were considered at critical or serious risk of bias. 8/11 non-randomised studies reported bacteriologically-confirmed CNR ratios between 0.47 (95% CI:0.41–0.53) and 0.96 (95% CI:0.94–0.97), with 7/11 reporting all-form CNR ratios between 0.96 (95% CI:0.88–1.05) and 1.09 (95% CI:1.02–1.16). One high-quality randomised-controlled trial reported a ratio of 1.14 (95% CI 0.91–1.43). KAP/qualitative manuscripts provided insufficient evidence to establish the impact of ACF on subsequent TB testing behaviour. ACF interventions with routine CNR ratios >1 suggest an indirect effect on wider TB case-detection, potentially due to impact on subsequent TB testing behaviour through follow-up after a negative ACF test or increased TB knowledge. However, data on this type of impact are rarely collected. Evaluation of routine case-notification, testing and proxy behavioural outcomes in intervention and comparator communities should be included as standard methodology in future ACF campaign study designs.

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 The Impact of Improved Data Collection at the Ibadan Cancer Registry: Comparison of Two Time Periods (2009-2012 and 2013-2016)

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 155s-155s
Author(s):  
G. Ogun ◽  
O. Bodunwa ◽  
A. Ladipo ◽  
O. Fabowale ◽  
O. Ogunbiyi
Keyword(s):  
Data Collection ◽  
Cancer Registry ◽  
Local Governments ◽  
Cancer Registries ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case ◽  
Time Period ◽  
Ranking Order ◽  
The Impact

Background and context: The Ibadan cancer registry is a population based registry that actively recruits cases of cancer occurring in eleven local government areas in Ibadan and its environs in Southwest, Nigeria. The registry covers a catchment area with a documented population of 2,549,265. Cases are abstracted from the main teaching hospital, designated private hospitals and clinics representing active practices, National Population Commission and private laboratories. We observed a decline in numbers of cases registered compared with what was projected and moved to effect corrections to this decline. In addition to reviewing our usual sources, we enlisted more sources of case recruitment. Aim: This study was done to assess the impact of additional sources of data collection on the number of cases recorded in the registry. Strategy/Tactics: The registry had improved contact with the local Ministry of Health and local governments administration, identified new facilities that treat cancer patients and new histopathologic laboratories that diagnose cancers. Program/Policy process: The registry enlisted cases from thirty (30) sources during 2009-2012 time period. In the 2013-2016 period, the registry improved the data collection sources to sixty (60) due to good advocacy, improved collaborative effort with our partners and very active case finding. Outcomes: A total of 3116 cases were recorded in the registry during the period 2009-2012. This increased to 3744 in the period 2013-2016 giving a 20% increase in the number of abstracted cases in the latter period. The ranking order of cancer in the population we serve changed from breast, cervix and prostate cancers in 2009-2012 to breast, prostate and cervix in the second time period. The ranking order in both genders did not change significantly. What was learned: Changes in health providing facilities affect the recruitment of new cancer cases into the database of cancer registries. Furthermore, cancer registries must always improve the database of sources where cases are recruited, as this is dynamic. Good advocacy, very active case finding and improved relation with the community have increased the number of cases of cancer recorded in our registry.

scholarly journals Predicting the impact of control strategies on the tuberculosis burden in South and North Korea using a mathematical model

2021 ◽  
Vol 6 (10) ◽  
pp. e005953
Author(s):  
Hyunwoo Cho ◽  
Youngmok Park ◽  
Jeongjoo Seok ◽  
Joon Sup Yeom ◽  
Jun Yong Choi ◽  
...  
Keyword(s):  
South Korea ◽  
North Korea ◽  
Control Strategies ◽  
Case Finding ◽  
Active Case Finding ◽  
Ltbi Treatment ◽  
Active Case ◽  
Number Of Patients ◽  
Mdr Tb ◽  
The Impact

BackgroundAmong high-income countries, South Korea has a considerable tuberculosis (TB) burden; North Korea has one of the highest TB burdens in the world. Predicting the impact of control strategies on the TB burden can help to efficiently implement TB control programmes.MethodsWe designed a deterministic compartmental model of TB in Korea. After calibration with notification of incidence data from South Korea, the TB burden for 2040 was predicted according to four different intervention strategies: latent TB infection (LTBI) treatment, rapid diagnosis, active case-finding and improvement of the treatment success rate. North Korea’s burden in 2040 was similarly estimated by adjusting the model parameters.ResultsIn South Korea, the number of patients with drug-susceptible TB (DS-TB) and multidrug-resistant TB (MDR-TB) were predicted to be 27 581 and 625, respectively, in 2025. Active case-finding would lower DS-TB by 6.2% and MDR-TB by 26.7%, respectively, in 2040. The improvement in the success rate of DS-TB treatment would reduce the MDR-TB burden by 34.5%. In North Korea, the number of patients with DS-TB and MDR-TB are, respectively, predicted to be 77 629 and 5409 in 2025. Active case-finding would reduce DS-TB by 22.2% and MDR-TB by 69.7%. LTBI treatment would reduce DS-TB by 20.6% and MDR-TB by 38.6%.ConclusionThe impact of control strategies on the TB burden in South and North Korea was investigated using a mathematical model. The combined intervention strategies would reduce the burden and active case-finding is expected to result in considerable reduction in both South and North Korea.

scholarly journals Investment Case for a Comprehensive Package of Interventions Against Hepatitis B in China: Applied Modeling to Help National Strategy Planning

2020 ◽  
Author(s):  
Shevanthi Nayagam ◽  
Polin Chan ◽  
Kun Zhao ◽  
Elisa Sicuri ◽  
Xiaochun Wang ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Viral Hepatitis ◽  
Return On Investment ◽  
Antiviral Treatment ◽  
Scale Up ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case ◽  
Chronic Hepatitis B Virus ◽  
The Impact

Abstract Background In 2016, the first global viral hepatitis elimination targets were endorsed. An estimated one-third of the world’s population of individuals with chronic hepatitis B virus (HBV) infection live in China and liver cancer is the sixth leading cause of mortality, but coverage of first-line antiviral treatment was low. In 2015, China was one of the first countries to initiate a consultative process for a renewed approach to viral hepatitis. We present the investment case for the scale-up of a comprehensive package of HBV interventions. Methods A dynamic simulation model of HBV was developed and used to simulate the Chinese HBV epidemic. We evaluated the impact, costs, and return on investment of a comprehensive package of prevention and treatment interventions from a societal perspective, incorporating costs of management of end-stage liver disease and lost productivity costs. Results Despite the successes of historical vaccination scale-up since 1992, there will be a projected 60 million people still living with HBV in 2030 and 10 million HBV-related deaths, including 5.7 million HBV-related cancer deaths between 2015 and 2030. This could be reduced by 2.1 million by highly active case-finding and optimal antiviral treatment regimens. The package of interventions is likely to have a positive return on investment to society of US$1.57 per US dollar invested. Conclusions Increases in HBV-related deaths for the next few decades pose a major public health threat in China. Active case-finding and access to optimal antiviral treatment are required to mitigate this risk. This investment case approach provides a real-world example of how applied modeling can support national dialog and inform policy planning.

scholarly journals The impact of active case finding on transmission dynamics of tuberculosis: A modelling study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0257242
Author(s):  
Diepreye Victoria Ayabina ◽  
M. Gabriela M. Gomes ◽  
Nhung Viet Nguyen ◽  
Luan Vo ◽  
Suvesh Shreshta ◽  
...  
Keyword(s):  
Reproduction Number ◽  
Treatment Success ◽  
National Level ◽  
Case Finding ◽  
Transmission Model ◽  
Active Case Finding ◽  
Active Case ◽  
Incidence Data ◽  
Country Level ◽  
The Impact

Background In the last decade, active case finding (ACF) strategies for tuberculosis (TB) have been implemented in many diverse settings, with some showing large increases in case detection and reporting at the sub-national level. There have also been several studies which seek to provide evidence for the benefits of ACF to individuals and communities in the broader context. However, there remains no quantification of the impact of ACF with regards to reducing the burden of transmission. We sought to address this knowledge gap and quantify the potential impact of active case finding on reducing transmission of TB at the national scale and further, to determine the intensification of intervention efforts required to bring the reproduction number (R0) below 1 for TB. Methods We adopt a dynamic transmission model that incorporates heterogeneity in risk to TB to assess the impact of an ACF programme (IMPACT TB) on reducing TB incidence in Vietnam and Nepal. We fit the models to country-level incidence data using a Bayesian Markov Chain Monte Carlo approach. We assess the impact of ACF using a parameter in our model, which we term the treatment success rate. Using programmatic data, we estimate how much this parameter has increased as a result of IMPACT TB in the implementation districts of Vietnam and Nepal and quantify additional efforts needed to eliminate transmission of TB in these countries by 2035. Results Extending the IMPACT TB programme to national coverage would lead to moderate decreases in TB incidence and would not be enough to interrupt transmission by 2035. Decreasing transmission sufficiently to bring the reproduction number (R0) below 1, would require a further intensification of current efforts, even at the sub-national level. Conclusions Active case finding programmes are effective in reducing TB in the short term. However, interruption of transmission in high-burden countries, like Vietnam and Nepal, will require comprehensive incremental efforts. Complementary measures to reduce progression from infection to disease, and reactivation of latent infection, are needed to meet the WHO End TB incidence targets.

scholarly journals Trade-offs between cost and accuracy in active case finding for tuberculosis: A dynamic modelling analysis

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003456
Author(s):  
Lucia Cilloni ◽  
Katharina Kranzer ◽  
Helen R. Stagg ◽  
Nimalan Arinaminpathy
Keyword(s):  
High Accuracy ◽  
Case Finding ◽  
Rifampicin Resistance ◽  
Active Case Finding ◽  
Line Treatment ◽  
Second Line ◽  
Active Case ◽  
Accuracy Test ◽  
The Impact ◽  
Slum Population

Background Active case finding (ACF) may be valuable in tuberculosis (TB) control, but questions remain about its optimum implementation in different settings. For example, smear microscopy misses up to half of TB cases, yet is cheap and detects the most infectious TB cases. What, then, is the incremental value of using more sensitive and specific, yet more costly, tests such as Xpert MTB/RIF in ACF in a high-burden setting? Methods and findings We constructed a dynamic transmission model of TB, calibrated to be consistent with an urban slum population in India. We applied this model to compare the potential cost and impact of 2 hypothetical approaches following initial symptom screening: (i) ‘moderate accuracy’ testing employing a microscopy-like test (i.e., lower cost but also lower accuracy) for bacteriological confirmation and (ii) ‘high accuracy’ testing employing an Xpert-like test (higher cost but also higher accuracy, while also detecting rifampicin resistance). Results suggest that ACF using a moderate-accuracy test could in fact cost more overall than using a high-accuracy test. Under an illustrative budget of US$20 million in a slum population of 2 million, high-accuracy testing would avert 1.14 (95% credible interval 0.75–1.99, with p = 0.28) cases relative to each case averted by moderate-accuracy testing. Test specificity is a key driver: High-accuracy testing would be significantly more impactful at the 5% significance level, as long as the high-accuracy test has specificity at least 3 percentage points greater than the moderate-accuracy test. Additional factors promoting the impact of high-accuracy testing are that (i) its ability to detect rifampicin resistance can lead to long-term cost savings in second-line treatment and (ii) its higher sensitivity contributes to the overall cases averted by ACF. Amongst the limitations of this study, our cost model has a narrow focus on the commodity costs of testing and treatment; our estimates should not be taken as indicative of the overall cost of ACF. There remains uncertainty about the true specificity of tests such as smear and Xpert-like tests in ACF, relating to the accuracy of the reference standard under such conditions. Conclusions Our results suggest that cheaper diagnostics do not necessarily translate to less costly ACF, as any savings from the test cost can be strongly outweighed by factors including false-positive TB treatment, reduced sensitivity, and foregone savings in second-line treatment. In resource-limited settings, it is therefore important to take all of these factors into account when designing cost-effective strategies for ACF.

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