Is it feasible to carry out active case finding for tuberculosis in community-based settings?

OBJECTIVE: To systematically screen older rural populations in Cambodia for tuberculosis (TB) and develop an effective active case-finding (ACF) model for this TB high-risk group.DESIGN: A retrospective study using routinely collected programmatic data on community-based ACF among people aged ≥55 years using TB symptoms and systematic chest radiography (CXR) screening, followed by Xpert® MTB/RIF testing for participants with positive screening results and TB culture for certain Xpert-negative specimens.RESULTS: Of 22 101 participants included in the analysis, 7469 (33.8%) were screening-positive and 5960 (27.0%) underwent Xpert testing. Pulmonary TB was identified in 482 (2.2%) individuals: 288 (1.3%) were bacteriologically confirmed (253 using Xpert, 35 using culture) and 194 (0.9%) were clinically diagnosed. Eighty-seven people needed to be screened in order to diagnose one Xpert-positive case. Among the Xpert-positive cases, only 31.6% (80/253) reported cough ≥2 weeks, and 39.9% (101/253) were asymptomatic but had a CXR suggestive of active TB. Treatment uptake was 97.3% (469/482), and treatment success was 88.0% (424/482).CONCLUSIONS: Community-based ACF was effective in detecting and successfully treating older TB patients, most of whom might otherwise have remained undiagnosed. Mobile CXR appears to be crucial in identifying a high number of asymptomatic, bacteriologically confirmed cases.

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Correction to: Role of community-based active case finding in screening tuberculosis in Yunnan province of China

Infectious Diseases of Poverty ◽

10.1186/s40249-020-0625-6 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Jin-Ou Chen ◽

Yu-Bing Qiu ◽

Zulma Vanessa Rueda ◽

Jing-Long Hou ◽

Kun-Yun Lu ◽

...

Keyword(s):

Yunnan Province ◽

Case Finding ◽

Active Case Finding ◽

Community Based ◽

Active Case

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Active case finding of tuberculosis among household contacts of newly diagnosed tuberculosis patients: A community-based study from southern Haryana

Journal of Family Medicine and Primary Care ◽

10.4103/jfmpc.jfmpc_532_20 ◽

2020 ◽

Vol 9 (7) ◽

pp. 3701

Author(s):

Vikas Gupta ◽

Suraj Chawla ◽

Neeraj Gour ◽

Kashish Grover ◽

PawanKumar Goel ◽

...

Keyword(s):

Case Finding ◽

Active Case Finding ◽

Newly Diagnosed ◽

Community Based ◽

Tuberculosis Patients ◽

Active Case ◽

Household Contacts

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

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20193447 ◽

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.

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‘Student centered approach’ in implementing Community Based Active case finding for Tuberculosis in rural, Puducherry – A Qualitative evaluation

Indian Journal of Tuberculosis ◽

10.1016/j.ijtb.2021.09.009 ◽

2021 ◽

Author(s):

Reenaa Mohan ◽

Ganapathi Kalaiselvan ◽

Vinayagamoorthy Venugopal ◽

Keerthiseelan Vivekananda

Keyword(s):

Qualitative Evaluation ◽

Case Finding ◽

Active Case Finding ◽

Community Based ◽

Student Centered ◽

Active Case

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Comparative Yield of Tuberculosis during Active Case Finding Using GeneXpert or Smear Microscopy for Diagnostic Testing in Nepal: A Cross-Sectional Study

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020050 ◽

2021 ◽

Vol 6 (2) ◽

pp. 50

Author(s):

Suman Chandra Gurung ◽

Kritika Dixit ◽

Bhola Rai ◽

Raghu Dhital ◽

Puskar Raj Paudel ◽

...

Keyword(s):

Diagnostic Testing ◽

Scale Up ◽

Cross Sectional Study ◽

Case Finding ◽

Smear Microscopy ◽

Active Case Finding ◽

Community Based ◽

Cross Sectional ◽

Active Case ◽

And Control

This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening of social contacts of known index cases, TB camps in remote areas, and screening for hospital out-patient department (OPD) attendees. Symptomatic individuals were then tested using smear microscopy or GeneXpert MTB/RIF as first diagnostic test. Yield rates were compared for each intervention and diagnostic method. We evaluated additional cases notified from ACF interventions by comparing case notifications of the intervention and control districts using standard TB REACH methodology. The project identified 1092 TB cases. The highest yield was obtained from OPD screening at hospitals (n = 566/1092; 52%). The proportion of positive tests using GeneXpert (5.5%, n = 859/15,637) was significantly higher than from microscopy testing 2% (n = 120/6309). (OR = 1.4; 95%CI = 1.12–1.72; p = 0.0026). The project achieved 29% additionality in case notifications in the intervention districts demonstrating that GeneXpert achieved substantially higher case-finding yields. Therefore, to increase national case notification for TB, Nepal should integrate OPD screening using GeneXpert testing in every district hospital and scale up of community-based ACF of TB patient contacts nationally.

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

PLoS ONE ◽

10.1371/journal.pone.0130179 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0130179 ◽

Cited By ~ 26

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

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Early Evaluation of an Ultra-Portable X-ray System for Tuberculosis Active Case Finding

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6030163 ◽

2021 ◽

Vol 6 (3) ◽

pp. 163

Author(s):

Luan Nguyen Quang Vo ◽

Andrew Codlin ◽

Thuc Doan Ngo ◽

Thang Phuoc Dao ◽

Thuy Thi Thu Dong ◽

...

Keyword(s):

Image Quality ◽

Case Finding ◽

Active Case Finding ◽

Community Based ◽

X Ray ◽

Early Evaluation ◽

Active Case ◽

Portable System ◽

Quality Rating ◽

Image Quality Rating

X-ray screening is an important tool in tuberculosis (TB) prevention and care, but access has historically been restricted by its immobile nature. As recent advancements have improved the portability of modern X-ray systems, this study represents an early evaluation of the safety, image quality and yield of using an ultra-portable X-ray system for active case finding (ACF). We reported operational and radiological performance characteristics and compared image quality between the ultra-portable and two reference systems. Image quality was rated by three human readers and by an artificial intelligence (AI) software. We deployed the ultra-portable X-ray alongside the reference system for community-based ACF and described TB care cascades for each system. The ultra-portable system operated within advertised specifications and radiologic tolerances, except on X-ray capture capacity, which was 58% lower than the reported maximum of 100 exposures per charge. The mean image quality rating from radiologists for the ultra-portable system was significantly lower than the reference (3.71 vs. 3.99, p < 0.001). However, we detected no significant differences in TB abnormality scores using the AI software (p = 0.571), nor in any of the steps along the TB care cascade during our ACF campaign. Despite some shortcomings, ultra-portable X-ray systems have significant potential to improve case detection and equitable access to high-quality TB care.

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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

PLOS Global Public Health ◽

10.1371/journal.pgph.0000088 ◽

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.

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