Active case finding for tuberculosis among high-risk groups in low-incidence countries [State of the art series. Case finding/screening. Number 3 in the series]

2013 ◽  
Vol 17 (5) ◽  
pp. 573-582 ◽  
Author(s):  
D. Zenner ◽  
J. Southern ◽  
R. van Hest ◽  
G. deVries ◽  
H. R. Stagg ◽  
...  
Keyword(s):  
High Risk ◽  
State Of The Art ◽  
Risk Groups ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case ◽  
Low Incidence

Active case-finding of tuberculosis in general populations and at-risk groups: a systematic review and meta-analysis

2021 ◽  
pp. 2100090
Author(s):  
Anders Solitander Bohlbro ◽  
Victor Schwartz Hvingelby ◽  
Frauke Rudolf ◽  
Christian Wejse ◽  
Cecilie Blenstrup Patsche
Keyword(s):  
At Risk ◽  
High Risk ◽  
Risk Groups ◽  
Case Finding ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Active Case Finding ◽  
Active Case ◽  
General Populations ◽  
Prevalence Ratios

The World Health Organization (WHO) recommends active case-finding (ACF) of Tuberculosis (TB) in certain high-risk groups; however, more evidence is needed to elucidate the scope of ACF beyond the current recommendations. In this study we aimed to systematically review yields (the prevalence of active TB) of studies on ACF in general populations and at-risk groups.The review protocol was registered with PROSPERO (registration no.: CRD42020206856). A literature search in PubMed, Embase, and CENTRAL was performed for studies concluded after 31/12/1999 and published before 01/09/2020. Screening yields were estimated and yield/prevalence ratios (ratio between yield of study and WHO estimated prevalence of TB) were calculated to assess which groups might especially benefit from ACF. Finally, risk of bias was assessed, and heterogeneity was investigated using meta-regression and sensitivity analyses.We included 197 studies, with a total of 12 372 530 screened and 53 158 cases found. Yields were high among drug users, close contacts, the poor and marginalised, people living with HIV (PLHIV), and prison inmates across incidence strata and estimated yield/prevalence ratios in screenings of general populations tended to be >1 with an overall ratio of 1.4 and ranging between 1.0 and 1.5. Sensitivity analyses suggested that inclusion of studies at high risk of bias contributed to underestimation of yields.Despite many studies using insensitive screening methods, these results suggest that more at-risk groups should be considered for inclusion in future screening recommendations and that screening of general populations may outperform current case-finding practices, providing evidence for extending ACF beyond the current recommendations.

scholarly journals Role of community-based active case finding in screening tuberculosis in Yunnan province of China

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jin-Ou Chen ◽  
Yu-Bing Qiu ◽  
Zulma Vanessa Rueda ◽  
Jing-Long Hou ◽  
Kun-Yun Lu ◽  
...  
Keyword(s):  
Public Health ◽  
High Risk ◽  
General Population ◽  
Yunnan Province ◽  
Risk Groups ◽  
Case Finding ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Incidence Proportion

Abstract Background The barriers to access diagnosis and receive treatment, in addition to insufficient case identification and reporting, lead to tuberculosis (TB) spreads in communities, especially among hard-to-reach populations. This study evaluated a community-based active case finding (ACF) strategy for the detection of tuberculosis cases among high-risk groups and general population in China between 2013 and 2015. Methods This retrospective cohort study conducted an ACF in ten communities of Dongchuan County, located in northeast Yunnan Province between 2013 and 2015; and compared to 136 communities that had passive case finding (PCF). The algorithm for ACF was: 1) screen for TB symptoms among community enrolled residents by home visits, 2) those with positive symptoms along with defined high-risk groups underwent chest X-ray (CXR), followed by sputum microscopy confirmation. TB incidence proportion and the number needed to screen (NNS) to detect one case were calculated to evaluate the ACF strategy compared to PCF, chi-square test was applied to compare the incidence proportion of TB cases’ demography and the characteristics for detected cases under different strategies. Thereafter, the incidence rate ratio (IRR) and multiple Fisher’s exact test were applied to compare the incidence proportion between general population and high-risk groups. Patient and diagnostic delays for ACF and PCF were compared by Wilcoxon rank sum test. Results A total of 97 521 enrolled residents were visited with the ACF cumulatively, 12.3% were defined as high-risk groups or had TB symptoms. Sixty-six new TB patients were detected by ACF. There was no significant difference between the cumulative TB incidence proportion for ACF (67.7/100000 population) and the prevalence for PCF (62.6/100000 population) during 2013 to 2015, though the incidence proportion in ACF communities decreased after three rounds active screening, concurrent with the remained stable prevalence in PCF communities. The cumulative NNS were 34, 39 and 29 in HIV/AIDS infected individuals, people with positive TB symptoms and history of previous TB, respectively, compared to 1478 in the general population. The median patient delay under ACF was 1 day (Interquartile range, IQR: 0–27) compared to PCF with 30 days (IQR: 14–61). Conclusions This study confirmed that massive ACF was not effective in general population in a moderate TB prevalence setting. The priority should be the definition and targeting of high-risk groups in the community before the screening process is launched. The shorter time interval of ACF between TB symptoms onset and linkage to healthcare service may decrease the risk of TB community transmission. Furthermore, integrated ACF strategy in the National Project of Basic Public Health Service may have long term public health impact.

scholarly journals Examining the sensitivity of the surveillance system to detect TB cases in Afghanistan

2020 ◽  
Author(s):  
Naqibullah Hamdard ◽  
Alim Atarud ◽  
Khalid Seddiq ◽  
Anwar Hanif
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Surveillance System ◽  
Risk Groups ◽  
Case Finding ◽  
World Health ◽  
Active Case Finding ◽  
Active Case ◽  
Primary Health

Abstract BackgroundTuberculosis (TB) remains a global public health threat. World Health Organization (WHO) End TB strategy recommends that effective TB control relies on general health systems, especially, on integrated and well-functioning PHC facilities. Despite, integration in Basic Package of Health Services (BPHS), evidence demonstrates that a large number of TB cases are not captured. 25000 TB cases are missed every year (Aloudal, 2015). 49% of individuals, recorded at health facilities as presumptive to have TB have not been screened (HMIS, 2016). This study intended to evaluate different dimensions of TB surveillance system and the Primary Health Care (PHC) facilities' role in TB active case finding. MethodsWe conducted a cross-sectional study. The study was implemented in eleven provinces of Afghanistan in from August to November 2016. The geographic and demographic representativeness determined the choice of provinces. All primary health care facilities in studied provinces equated to 870, therefore, considering a 95 % confidence interval, a sample size of 161 facilities established the sample frame. A stratified sampling strategy facilitated the selection of sampled facilities within different categories from an inclusive list of all facilities.ResultsThe study found that the overall sensitivity of TB surveillance systems in-country is 56.30 %. This means that 43.70 % of 171 TB cases had remained undetected. 43.81 % of studies facilities used at least one accepted active case finding strategy while 56.20 % implemented none. In studied areas, 83.33 % of 11 studied DHs and 69.57 % of 35 studied CHCs had a referral system for MDR-TB patients.ConclusionTo enhance sensitivity and boost case findings, it is essential to implement case-finding strategies targeted at high-risk groups in specific areas. The high-risk groups include IDPs, returnees, slum residents, prisoners, and addicts. Additionally, it is necessary to train private pharmacists and traditional healers to identify and refer individuals with TB symptoms for follow up and further evaluation at the PHC level.

scholarly journals Bringing state-of-the-art diagnostics to vulnerable populations: The use of a mobile screening unit in active case finding for tuberculosis in Palawan, the Philippines

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0171310 ◽  
Author(s):  
Fukushi Morishita ◽  
Anna Marie Celina Gonzales Garfin ◽  
Woojin Lew ◽  
Kyung Hyun Oh ◽  
Rajendra-Prasad Yadav ◽  
...  
Keyword(s):  
Vulnerable Populations ◽  
State Of The Art ◽  
The Philippines ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case ◽  
Screening Unit ◽  
Mobile Screening

scholarly journals Feasibility and effectiveness of tuberculosis active case-finding among children living with tuberculosis relatives: a cross sectional study in Guinea-Bissau ”

2017 ◽  
Vol 9 (1) ◽  
pp. e2017059
Author(s):  
Raffaella Colombatti
Keyword(s):  
Family Members ◽  
Risk Groups ◽  
Case Finding ◽  
Adult Patients ◽  
Sputum Smear ◽  
Personnel Cost ◽  
Active Case Finding ◽  
Pulmonary Tb ◽  
Active Case ◽  
Guinea Bissau

Background and Objectives: The World Health Organization End tuberculosis (TB) Strategy, approved in 2014, aims at a 90% reduction in TB deaths and an 80% reduction in TB incidence rate by 2030. One of the suggested interventions is the systematic screening of people with suspected TB, belonging to specific risk groups. The Hospital Raoul Follereau (HRF) in Bissau, Guinea-Bissau, is the National Reference Hospital for Tuberculosis and Lung Disease of the country. We performed an active case-finding program among pediatric age family members and cohabitants of admitted adult TB patients, from January to December 2013.Methods: Newly admitted adult patients with a diagnosis of TB were invited to bring their family members or cohabitants in childhood age for clinical evaluation in a dedicated outpatient setting within the hospital compound. All the children brought to our attention underwent medical examination and chest x-ray. In children with clinical and/or radiologic finding consistent with pulmonary TB a sputum-smear was requested.Results: All admitted adult patients accepted to bring their children cohabitants. In total, 287 children were examined in 2013. Forty-four patients (15%) were diagnosed with TB. The number needed to screen (NNS) to detect one case of TB was 7. 35 patients (80%) had pulmonary TB; 2 of them were sputum smear-positive. No adjunctive personnel cost was necessary for the intervention.Conclusions: children with TB represent a large proportion of the pool of undetected TB. A simple TB active case-finding program targeted to high risk groups like children households of severely ill admitted patients with TB can successfully be implemented in a country with limited resources.

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 Tuberculosis among never-jailed drug abusers

2001 ◽  
Vol 7 (3) ◽  
pp. 461-464
Author(s):  
M. Askarian ◽  
A. Karmi
Keyword(s):  
High Risk ◽  
General Population ◽  
Pulmonary Tuberculosis ◽  
Skin Test ◽  
Risk Groups ◽  
Case Finding ◽  
Drug Abusers ◽  
Drug Addicts ◽  
Active Case Finding ◽  
Over 40 Years

The best way to control tuberculosis in a community is active case-finding and treatment among high-risk groups. Upon admission to a correctional centre in 1997, 319 never-jailed drug addicts were enrolled in the present study. Statistically significant differences in skin-test positivity were found among males over 40 years old, those unemployed and injecting drug abusers. Among the sample, 8 cases of pulmonary tuberculosis were found. This is approximately 170 times the rate in the general population. Because of cost and time, we recommend the screening of drug addicts by mini-radiography instead of tuberculin skin test at admission.

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