A Multi-Site Evaluation of Innovative Approaches to Increase Tuberculosis Case Notification: Summary Results

Abstract

BackgroundGlobally, TB notifications have stagnated since 2007, and sputum smear positive notifications have been declining despite policies to improve case detection. We evaluate results of 28 interventions focused on improving TB case detection.MethodsWe measured additional sputum smear positive cases treated, defined as the intervention area's increase in case notification during the project compared to the previous year. Projects were encouraged to select control areas and collect historical notification data. We used time series negative binomial regression for over-dispersed cross-sectional data accounting for fixed and random effects to test the individual projects' effects on TB notification while controlling for trend and control populations.ResultsTwenty-eight projects, 19 with control populations, completed at least four quarters of case finding activities, covering a population of 89.2 million. Among all projects sputum smear positive (SS+) TB notifications increased 24.9% and annualized notification rates increased from 69.1 to 86.2/100,000 (p = 0.0209) during interventions. Among the 19 projects with control populations, SS+TB case notifications increased 36.9% increase while in the control populations a 3.6% decrease was observed. Fourteen (74%) of the 19 projects' SS+TB notification rates in intervention areas increased from the baseline to intervention period when controlling for historical trends and notifications in control areas.ConclusionsInterventions were associated with large increases in TB notifications across many settings, using an array of interventions. Many people with TB are not reached using current approaches. Different methods and interventions tailored to local realities are urgently needed.

BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing

“…Since 2010, not only have guidelines been released to promote ACF among contacts of TB cases [5] and people living with HIV [4] but competitive funding has become available to support ACF in TB high burden settings [8, 17]. Emerging data now demonstrates that ACF is not only feasible but affords high yield in TB high burden settings [9].…”

“…The yield of contact tracing is dependent on a number of factors [8, 9]. Yield increases directly as the prevalence of TB increases in the population and the infectivity of the index increases.…”

“…Fueled by the Stop TB Partnership TB REACH initiative, innovative approaches to ACF have increased among populations thought to have increased risk of developing TB across a spectrum of settings [8]. Meta-analysis of these recent initiatives demonstrated that program yield and contribution to case detection are dependent on program design and implementation [9].…”

Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment

“…Since the 1930s, a range of approaches to targeted active case-fi nding, tailored to local epidemiology, have been shown to improve tuberculosis case detection. 6,20,21 By focusing on populations at high risk for tuberculosis, targeted active case-fi nding strategies detect substantially more cases per number of people assessed than would be detected by screening in the general population. The expected yields of a few common approaches are described in table 1.…”

“…However, diff erent characteristics are associated with increased tuberculosis risk in diff erent places, and the effi cacy of any single approach to active case-fi nding can vary widely across settings. 20 Thus, each tuberculosis programme has to identify what combination of targeted active case-fi nding activities is the most eff ective in the local context.…”