A pragmatic approach to measuring, monitoring and evaluating interventions for improved tuberculosis case detection

Blok, Lucie; Creswell, Jacob; Stevens, Robert; Brouwer, Miranda; Ramis, Oriol; Weil, Olivier; Klatser, Paul; Sahu, Suvanand; Bakker, Mirjam I.

doi:10.1093/inthealth/ihu055

Cited by 48 publications

(57 citation statements)

References 40 publications

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“…It is important to note that, although a successful screening program may detect and confirm many cases of TB, these are not necessarily all going to be cases who would have failed to seek care in the absence of contact investigation[ 31 ]. To justify the additional resources required, it is crucial that the effect of contact investigation on case notification and ultimately on disease transmission be studied.…”

Section: Discussionmentioning

confidence: 99%

Comparative Meta-Analysis of Tuberculosis Contact Investigation Interventions in Eleven High Burden Countries

et al. 2015

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BackgroundScreening of household contacts of tuberculosis (TB) patients is a recommended strategy to improve early case detection. While it has been widely implemented in low prevalence countries, the most optimal protocols for contact investigation in high prevalence, low resource settings is yet to be determined. This study evaluated contact investigation interventions in eleven lower and middle income countries and reviewed the association between context or program-related factors and the yield of cases among contacts.MethodsWe reviewed data from nineteen first wave TB REACH funded projects piloting innovations to improve case detection. These nineteen had fulfilled the eligibility criteria: contact investigation implementation and complete data reporting. We performed a cross-sectional analysis of the percentage yield and case notifications for each project. Implementation strategies were delineated and the association between independent variables and yield was analyzed by fitting a random effects logistic regression.FindingsOverall, the nineteen interventions screened 139,052 household contacts, showing great heterogeneity in the percentage yield of microscopy confirmed cases (SS+), ranging from 0.1% to 6.2%). Compared to the most restrictive testing criteria (at least two weeks of cough) the aOR’s for lesser (any TB related symptom) and least (all contacts) restrictive testing criteria were 1.71 (95%CI 0.94−3.13) and 6.90 (95% CI 3.42−13.93) respectively. The aOR for inclusion of SS- and extra-pulmonary TB was 0.31 (95% CI 0.15−0.62) compared to restricting index cases to SS+ TB. Contact investigation contributed between <1% and 14% to all SS+ cases diagnosed in the intervention areas.ConclusionsThis study confirms that high numbers of active TB cases can be identified through contact investigation in a variety of contexts. However, design and program implementation factors appear to influence the yield of contact investigation and its concomitant contribution to TB case detection.

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Section: Discussionmentioning

confidence: 99%

Comparative Meta-Analysis of Tuberculosis Contact Investigation Interventions in Eleven High Burden Countries

et al. 2015

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“…Thus, case detection of TB will be more challenging in this region. Although health care providers raised concern about passive case finding in our study, active case finding requires financial resources, time, laboratory capacity and supply chain [ 21 ]. Mass media campaigns for raising awareness, community engagement and strong partnerships with employers of migrant workers may address the issue [ 9 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals

Kaji

Thi

Smith³

et al. 2015

BMC Health Serv Res

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BackgroundMyanmar and Thailand belong to the top 22 high burden countries for tuberculosis (TB). Health care organizations play an essential role in addressing TB control in the two bridging border jurisdictions, Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. However, health professionals face difficulties in TB control effort due to the nature of fluid population movements, resource constraints and ambiguous mechanisms to implement collaboration along the border. The purpose of this study is to identify the challenges to TB control among Myanmar migrants faced by stakeholders, focusing on the area of collaboration and interaction along the border.MethodThe study conducted in-depth interviews with health policy makers and health care providers responsible for developing and implementing policies and TB programs in Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. The participants included members of government organizations, United Nations agencies, community based organizations, and international NGO. One or two key stakeholders from each organization were approached to participate in the study. We gathered baseline information to identify TB policies and programs available on websites, brochures, and publications. Observations including field notes were made on site. The data transcriptions were coded for qualitative data analysis. Coding also developed categories that led to key themes.ResultsA total of 31 respondents (18 in Thailand and 13 in Myanmar) participated in the study. The main theme reported by participants was challenges in limited corroboration and coordination among stakeholders. Unstructured information sharing and lack of communication hindered the stakeholders from engaging in TB control. The respondents stressed that referral mechanisms across the border need to be strengthened. Other challenges were associated with increasing loss to follow up and subsequent MDR cases, constraints of service delivery, shortage of human resources, limited staff capacities within organizations and poor socioeconomic status of patients.ConclusionsHealth professionals face many challenges in effectively addressing TB control. Addressing the insufficient coordination and collaboration by strengthening bi-national collaborative mechanisms among health care organizations is an essential step in reducing the burden of disease. Additional support and resources from governmental and non-governmental agencies will be required to address the challenges.

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“…Program impact was also assessed by additional notifications, which are a programmatic and pragmatic measure that explicitly includes improvements in surveillance data quality in its definition [15]. This method of ongoing outcome monitoring compared the number of health events recorded in project data to population-level registers and allowed recording errors and registrations outside the six BMU evaluation population to be investigated, and variations between project sites to be explored against an independent data source.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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BackgroundLimited data exists to inform contact tracing guidelines in children and HIV-affected populations. We evaluated the yield and additionality of household contact and source case investigations in Swaziland, a TB/HIV high-burden setting, while prioritizing identification of childhood TB.MethodsIn partnership with 7 local TB clinics, we implemented standardized contact tracing of index cases (IC) receiving TB treatment. Prioritizing child contacts and HIV-affected households, screening officers screened contacts for TB symptoms and to identify risk factors associated with TB. We ascertained factors moderating the yield of contact tracing and measured the impact of our program by additional notifications.ResultsFrom March 2013 to November 2015, 3,258 ICs (54% bacteriologically confirmed; 70% HIV-infected; 85% adults) were enrolled leading to evaluation of 12,175 contacts (median age 18 years, IQR 24–42; 45% children; 9% HIV-infected). Among contacts, 196 TB cases (56% bacteriologically confirmed) were diagnosed resulting in a program yield of 1.6% for all forms of TB. The number needed to screen (NNS) to identify a bacteriologically confirmed TB case or all forms TB case traced from a child IC <5 years was respectively 62% and 40% greater than the NNS for tracing from an adult IC. In year one, we demonstrated a 32% increase in detection of bacteriologically confirmed child TB. Contacts were more likely to have TB if <5 years (OR = 2.0), HIV-infected (OR = 4.9), reporting ≥1 TB symptoms (OR = 7.7), and sharing a bed (OR = 1.7) or home (OR = 1.4) with the IC. There was a 1.4 fold increased chance of detecting a TB case in households known to be HIV-affected.ConclusionContact tracing prioritizing children is not only feasible in a TB/HIV high-burden setting but contributes to overall case detection. Our findings support WHO guidelines prioritizing contact tracing among children and HIV-infected populations while highlighting potential to integrate TB and HIV case finding.

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A pragmatic approach to measuring, monitoring and evaluating interventions for improved tuberculosis case detection

Cited by 48 publications

References 40 publications

Comparative Meta-Analysis of Tuberculosis Contact Investigation Interventions in Eleven High Burden Countries

Comparative Meta-Analysis of Tuberculosis Contact Investigation Interventions in Eleven High Burden Countries

Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals

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

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