scholarly journals Active Case Finding for Tuberculosis in India: A Syntheses of Activities and Outcomes Reported by the National Tuberculosis Elimination Programme

2021 ◽  
Vol 6 (4) ◽  
pp. 206
Author(s):  
Sharath Burugina Nagaraja ◽  
Pruthu Thekkur ◽  
Srinath Satyanarayana ◽  
Prathap Tharyan ◽  
Karuna D. Sagili ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Case Finding ◽  
Sputum Smear ◽  
X Rays ◽  
National Data ◽  
Community Based ◽  
Implementation Challenges ◽  
Number Needed To Screen ◽  
National Tuberculosis ◽  
Elimination Programme

India launched a national community-based active TB case finding (ACF) campaign in 2017 as part of the strategic plan of the National Tuberculosis Elimination Programme (NTEP). This review evaluated the outcomes for the components of the ACF campaign against the NTEP’s minimum indicators and elicited the challenges faced in implementation. We supplemented data from completed pretested data proformas returned by ACF programme managers from nine states and two union territories (for 2017–2019) and five implementing partner agencies (2013–2020), with summary national data on the state-wise ACF outcomes for 2018–2020 published in annual reports by the NTEP. The data revealed variations in the strategies used to map and screen vulnerable populations and the diagnostic algorithms used across the states and union territories. National data were unavailable to assess whether the NTEP indicators for the minimum proportions identified with presumptive TB among those screened (5%), those with presumptive TB undergoing diagnostic tests (>95%), the minimum sputum smear positivity rate (2% to 3%), those with negative sputum smears tested with chest X-rays or CBNAAT (>95%) and those diagnosed through ACF initiated on anti-TB treatment (>95%) were fulfilled. Only 30% (10/33) of the states in 2018, 23% (7/31) in 2019 and 21% (7/34) in 2020 met the NTEP expectation that 5% of those tested through ACF would be diagnosed with TB (all forms). The number needed to screen to diagnose one person with TB (NNS) was not included among the NTEP’s programme indicators. This rough indicator of the efficiency of ACF varied considerably across the states and union territories. The median NNS in 2018 was 2080 (interquartile range or IQR 517–4068). In 2019, the NNS was 2468 (IQR 1050–7924), and in 2020, the NNS was 906 (IQR 108–6550). The data consistently revealed that the states that tested a greater proportion of those screened during ACF and used chest X-rays or CBNAAT (or both) to diagnose TB had a higher diagnostic yield with a lower NNS. Many implementation challenges, related to health systems, healthcare provision and difficulties experienced by patients, were elicited. We suggest a series of strategic interventions addressing the implementation challenges and the six gaps identified in ACF outcomes and the expected indicators that could potentially improve the efficacy and effectiveness of community-based ACF in India.

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.

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 Case finding of tuberculosis among mining communities in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248718
Author(s):  
Sally-Ann Ohene ◽  
Frank Bonsu ◽  
Yaw Adusi-Poku ◽  
Francisca Dzata ◽  
Mirjam Bakker
Keyword(s):  
Secondary Data ◽  
Diagnostic Value ◽  
Case Finding ◽  
Screening Methods ◽  
X Rays ◽  
Mining Communities ◽  
X Ray ◽  
Factors Associated ◽  
Number Needed To Screen ◽  
Symptom Screening

Background Data on active TB case finding activities among artisanal gold mining communities (AMC) is limited. The study assessed the yield of TB cases from the TB screening activities among AMC in Ghana, the factors associated with TB in these communities and the correlation between the screening methods and a diagnosis of TB. Methods We conducted secondary data analyses of NTP program data collected from TB case finding activities using symptom screening and mobile X-ray implemented in hard to reach AMC. Yield of TB cases, number needed to screen (NNS) and the number needed to test (NNT) to detect a TB case were assessed and logistic regression were conducted to assess factors associated with TB. The performance of screening methods chest X-ray and symptoms in the detection of TB cases was also evaluated. Results In total 10,441 people from 78 communities in 24 districts were screened, 55% were female and 60% (6,296) were in the aged 25 to 54 years. Ninety-five TB cases were identified, 910 TB cases per 100,000 population screened; 5.6% of the TB cases were rifampicin resistant. Being male (aOR 5.96, 95% CI 3.25–10.92, P < 0.001), a miner (aOR 2.70, 95% CI 1.47–4.96, P = 0.001) and age group 35 to 54 years (aOR 2.27, 95% CI 1.35–3.84, P = 0.002) were risk factors for TB. NNS and NNT were 110 and 24 respectively.; Cough of any duration had the strongest association with X-ray suggestive of TB with a correlation coefficient of 0.48. Cough was most sensitive for a diagnosis of TB; sensitivity of 86.3% (95% CI 79.4–93.2) followed by X-ray, sensitivity 81.1% (95% CI 71.7–88.4). The specificities of the symptoms and X-rays ranged from 80.2% (cough) to 97.3% (sputum). Conclusion The high risk of TB in the artisanal mining communities and in miners in this study reinforces the need to target these populations with outreach programs particularly in hard to reach areas. The diagnostic value of cough highlights the usefulness of symptom screening in this population that may be harnessed even in the absence of X-ray to identify those suspected to have TB for further evaluation.

PULMONARY TB

2006 ◽  
Vol 13 (04) ◽  
pp. 647-650
Author(s):  
FAISAL NAVEED AKHTAR ◽  
WARIS ALI RANA ◽  
SAJJAD AHMAD ANSARI ◽  
Imad Ahmed Toor
Keyword(s):  
Diagnostic Yield ◽  
Sampling Technique ◽  
Descriptive Study ◽  
Sampling Procedure ◽  
Sputum Smear ◽  
X Rays ◽  
Pulmonary Tb ◽  
Smear Negative ◽  
Selection Of Patients ◽  
Selection Of

Objective: To determine the diagnostic yield of microscopy of endobronchialsecretions collected by bronchoscopy in patients who were suspected to have pulmonary TB but their sputum smearwas negative for AFB with ZN staining. Study Design: Descriptive study. Place and Duration of Study: At MilitaryHospital Rawalpindi from June 2004 to May 2005. Subjects and Methods: Fifty patients were included in the study.Convenience sampling technique of non-probability sampling procedure was used for the selection of patients. Onlythose patients suspected to have pulmonary TB on clinical grounds, raised ESR and X-rays chest showing pulmonaryinfiltrates but sputum smear negative for AFB on a minimum of three examinations were included in the study.Bronchoscopy of these patients was done, endobronchial secretions taken and sent for microscopy for AFB. Results:Out of 50 patients, 16(32%) patients were positive for AFB while 34(68%) were negative on endobronchial secretion’smicroscopy. Conclusion: Microscopy of endobronchial secretions collected by bronchoscopy is a useful technique inthe diagnosis of pulmonary TB in patients who are suspected to have pulmonary TB but their sputum smear is negativefor AFB with ZN staining.

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 Integrated Tuberculosis/Human Immunodeficiency Virus Community-Based Case Finding in Rural South Africa: Implications for Tuberculosis Control Efforts

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Sheela V Shenoi ◽  
Anthony P. Moll ◽  
Ralph P. Brooks ◽  
Tassos Kyriakides ◽  
Laurie Andrews ◽  
...  
Keyword(s):  
South Africa ◽  
Human Immunodeficiency Virus ◽  
Hiv Testing ◽  
Case Finding ◽  
Hiv Positive ◽  
Community Based ◽  
Rural South ◽  
Number Needed To Screen ◽  
Immunodeficiency Virus ◽  
Rural South Africa

Abstract Background Intensive case finding is endorsed for tuberculosis (TB) control in high-risk populations. Novel case-finding strategies are needed in hard-to-reach rural populations with high prevalence of TB and human immunodeficiency virus (HIV). Methods We performed community-based integrated HIV and TB intensive case finding in a rural South African subdistrict from March 2010 to June 2012. We offered TB symptom screening, sputum collection for microbiologic diagnosis, rapid fingerstick HIV testing, and phlebotomy for CD4 cell count. We recorded number of cases detected and calculated population-level rates and number needed to screen (NNS) for drug-susceptible and -resistant TB. Results Among 5615 persons screened for TB at 322 community sites, 91.2% accepted concurrent HIV testing, identifying 510 (9.9%) HIV-positive individuals with median CD4 count of 382 cells/mm3 (interquartile range = 260–552). Tuberculosis symptoms were reported by 2049 (36.4%), and sputum was provided by 1033 (18.4%). Forty-one (4.0%) cases of microbiologically confirmed TB were detected for an overall case notification rate of 730/100000 (NNS = 137); 11 (28.6%) were multidrug-resistant or extensively drug-resistant TB. Only 5 (12.2%) TB cases were HIV positive compared with an HIV coinfection rate of 64% among contemporaneously registered TB cases (P = .001). Conclusion Community-based integrated intensive case finding is feasible and is high yield for drug-susceptible and -resistant TB and HIV in rural South Africa. Human immunodeficiency virus–negative tuberculosis predominated in this community sample, suggesting a distinct TB epidemiology compared with cases diagnosed in healthcare facilities. Increasing HIV/TB integrated community-based efforts and other strategies directed at both HIV-positive and HIV-negative tuberculosis may contribute to TB elimination in high TB/HIV burden regions.

scholarly journals Costs of TB services in India (No 1)

2021 ◽  
Vol 25 (12) ◽  
pp. 1013-1018
Author(s):  
S. Chatterjee ◽  
M. N. Toshniwal ◽  
P. Bhide ◽  
K. S. Sachdeva ◽  
R. Rao ◽  
...  
Keyword(s):  
Unit Cost ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Systems Perspective ◽  
Unit Costs ◽  
Multi Stage ◽  
National Tuberculosis ◽  
Elimination Programme ◽  
Line Drug ◽  
Children Under 5

BACKGROUND: There is a dearth of economic analysis required to support increased investment in TB in India. This study estimates the costs of TB services from a health systems´ perspective to facilitate the efficient allocation of resources by India´s National Tuberculosis Elimination Programme.METHODS: Data were collected from a multi-stage, stratified random sample of 20 facilities delivering TB services in two purposively selected states in India as per Global Health Cost Consortium standards and using Value TB Data Collection Tool. Unit costs were estimated using the top-down (TD) and bottom-up (BU) methodology and are reported in 2018 US dollars.RESULTS: Cost of delivering 50 types of TB services and four interventions varied according to costing method. Key services included sputum smear microscopy, Xpert® MTB/RIF and X-ray with an average BU costs of respectively US$2.45, US$17.36 and US$2.85. Average BU cost for bacille Calmette-Guérin vaccination, passive case-finding, TB prevention in children under 5 years using isoniazid and first-line drug treatment in new pulmonary and extrapulmonary TB cases was respectively US$0.76, US$1.62, US$2.41, US$103 and US$98.CONCLUSION: The unit cost of TB services and outputs are now available to support investment decisions, as diagnosis algorithms are reviewed and prevention or treatment for TB are expanded or updated in India.

scholarly journals Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar

2019 ◽  
Vol 5 (1) ◽  
pp. 2
Author(s):  
Nang Thu Thu Kyaw ◽  
Aung Sithu ◽  
Srinath Satyanarayana ◽  
Ajay M. V. Kumar ◽  
Saw Thein ◽  
...  
Keyword(s):  
Chest Radiography ◽  
Multidrug Resistant ◽  
Sputum Smear ◽  
Community Based ◽  
Household Contacts ◽  
Resistant Tuberculosis ◽  
Symptom Screening ◽  
Multidrug Resistant Tuberculosis ◽  
Screening Algorithm ◽  
Mdr Tb

Screening of household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) is a crucial active TB case-finding intervention. Before 2016, this intervention had not been implemented in Myanmar, a country with a high MDR-TB burden. In 2016, a community-based screening of household contacts of MDR-TB patients using a systematic TB-screening algorithm (symptom screening and chest radiography followed by sputum smear microscopy and Xpert-MTB/RIF assays) was implemented in 33 townships in Myanmar. We assessed the implementation of this intervention, how well the screening algorithm was followed, and the yield of active TB. Data collected between April 2016 and March 2017 were analyzed using logistic and log-binomial regression. Of 620 household contacts of 210 MDR-TB patients enrolled for screening, 620 (100%) underwent TB symptom screening and 505 (81%) underwent chest radiography. Of 240 (39%) symptomatic household contacts, 71 (30%) were not further screened according to the algorithm. Children aged <15 years were less likely to follow the algorithm. Twenty-four contacts were diagnosed with active TB, including two rifampicin- resistant cases (yield of active TB = 3.9%, 95% CI: 2.3%–6.5%). The highest yield was found among children aged <5 years (10.0%, 95% CI: 3.6%–24.7%). Household contact screening should be strengthened, continued, and scaled up for all MDR-TB patients in Myanmar.

scholarly journals Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Guesly J. Delva ◽  
Ingrid Francois ◽  
Cassidy W. Claassen ◽  
Darwin Dorestan ◽  
Barbara Bastien ◽  
...  
Keyword(s):  
Case Finding ◽  
Case Detection ◽  
Tuberculosis Case ◽  
Community Screening ◽  
Control Programs ◽  
Number Needed To Screen ◽  
Laboratory Services ◽  
Smear Negative ◽  
Hiv Negative

Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources.Methods.Mache Chache(“Go and Seek”) was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance.Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities.Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.

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