scholarly journals Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges

2019 ◽  
Vol 4 (4) ◽  
pp. 134 ◽  
Author(s):  
Abhijit Dey ◽  
Pruthu Thekkur ◽  
Ayan Ghosh ◽  
Tanusree Dasgupta ◽  
Soumyajyoti Bandopadhyay ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Case Finding ◽  
Health Facilities ◽  
Mixed Methods Study ◽  
Attrition Rate ◽  
Active Case Finding ◽  
Identification Rate ◽  
Implementation Challenges ◽  
Active Case ◽  
Number Needed To Screen

Active case finding (ACF) for tuberculosis (TB) was implemented in 60 selected high TB burden wards of Kolkata, India. Community volunteers called TOUCH (Targeted Outreach for Upliftment of Community Health) agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the “care cascade” of PTBPs that were identified during July to December 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. An explanatory mixed-methods study with a quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Of the 3,86242 individuals that were enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited a referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%). The number needed to screen for one TB patient was 2183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage losses for attending health facilities, and substance abuse among PTBPs. The yield of ACF was suboptimal with low PTBP identification rate and a high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

scholarly journals Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed-methods Study on Outcomes and Implementation Challenges

2019 ◽  
Author(s):  
Abhijit Dey ◽  
Pruthu Thekkur ◽  
Ayan Ghosh ◽  
Tanusree Dasgupta ◽  
Soumyajyoti Bandopadhyay ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Case Finding ◽  
Health Facilities ◽  
Mixed Methods Study ◽  
Attrition Rate ◽  
Active Case Finding ◽  
Identification Rate ◽  
Active Case ◽  
Number Needed To Screen ◽  
Wage Loss

Background: Active case finding for TB was implemented in selected sixty high TB burden wards of Kolkata, India. Community volunteers called TOUCH agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the ‘care cascade’ of PTBPs identified during July to December, 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. Methods: An explanatory mixed methods study with quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Results: Of the 3, 86,242 individuals enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%) and the number needed to screen for one TB was 2,183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage loss for attending health facilities and substance abuse among PTBPs. Conclusion: The yield of ACF was suboptimal with low PTBP identification rate and high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

scholarly journals Challenges from Tuberculosis Diagnosis to Care in Community-Based Active Case Finding among the Urban Poor in Cambodia: A Mixed-Methods Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (7) ◽  
pp. e0130179 ◽  
Author(s):  
Natalie Lorent ◽  
Kimcheng Choun ◽  
Shelly Malhotra ◽  
Pichenda Koeut ◽  
Sopheak Thai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Urban Poor ◽  
Case Finding ◽  
Mixed Methods Study ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Tuberculosis Diagnosis

Optimizing the efficiency of tuberculosis active case-finding in health facilities and communities

2019 ◽  
Vol 23 (7) ◽  
pp. 844-849
Author(s):  
C. M. Yuen ◽  
J. Agaya ◽  
W. Mchembere ◽  
D. Okelloh ◽  
M. Achola ◽  
...  
Keyword(s):  
Case Finding ◽  
Health Facilities ◽  
Active Case Finding ◽  
Active Case

scholarly journals Pre-diagnostic loss to follow-up in an active case-finding TB program: a mixed-methods study from rural Bihar, India

2019 ◽  
Author(s):  
Tushar Garg ◽  
Vivek Gupta ◽  
Dyuti Sen ◽  
Madhur Verma ◽  
Miranda Brouwer ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Health ◽  
Case Finding ◽  
Diagnostic Evaluation ◽  
List Type ◽  
Active Case Finding ◽  
Loss To Follow Up ◽  
The Public ◽  
Active Case

ABSTRACTbackgroundDespite active case-finding (ACF) identifying more presumptive and confirmed TB cases, high pre-diagnostic loss to follow-up (PDLFU) among presumptive TB cases referred for diagnostic test remains a concern. We aimed to quantify the PDLFU, and identify the barriers and enablers in undergoing a diagnostic evaluation in an ACF program implemented in 1.02 million rural population in the Samastipur district of Bihar, India.methodsDuring their routine work, Accredited Social Health Activists (ASHA, a community health worker or CHW), informal providers, and community laypersons identified people at risk of TB, and referred them to the program. A field coordinator (FC) screened them for TB symptoms at the patient’s home. The identified presumptive TB cases were accompanied by the CHW to a designated government facility for diagnostics. Those with a confirmed TB diagnosis were put on treatment by the CHW and followed-up till treatment completion. All services were provided free of cost and patients were supported throughout the care pathway, including a transport allowance. We analyzed programmatically collected data, conducted in-depth interviews with patients, and focus group discussions with the CHWs and FCs in an explanatory mixed-methods design.resultsA total of 11146 presumptive TB cases were identified from January 2018 to December 2018, out of which 4912 (44.1%) underwent a diagnostic evaluation. The key enablers were CHW accompaniment and support in addition to the free TB services in the public sector. The major barriers identified were transport challenges, deficient family and health provider support, and poor services in the public system.conclusionIf we are to find missing cases, the health system needs urgent reform, and diagnostic services need to be patient-centric. A strong patient support system engaging all stakeholders and involvement of CHWs in routine TB care is an effective solution.STRENGTHS AND LIMITATIONS OF THIS STUDYFirst such study to explore the reasons for pre-diagnostic loss to follow-upA mixed-method design including the views of both patients and community health workersUses operational data from a routine programmatic setting at an NGO siteNo record of the actual number of people screened intuitively before being referred to the program.No record of patients accessing diagnostics in private sector and those completing the diagnostic process.

scholarly journals Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12690
Author(s):  
Alvin Kuo Jing Teo ◽  
Kiesha Prem ◽  
Yi Wang ◽  
Tripti Pande ◽  
Marina Smelyanskaya ◽  
...  
Keyword(s):  
Experimental Study ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Case Finding ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Number Needed To Screen ◽  
Life Years ◽  
Quasi Experimental

This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.

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

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033706 ◽  
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.

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