Active Case Finding of Pulmonary Tuberculosis through Screening of Respiratory Symptomatics Using Sputum Microscopy: Is It Time to Change the Paradigm?

Abstract

Background. One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with PTB. Although this is programmatic strategy for active case finding, its yield is not well known. Objective. To determine the yield of pulmonary tuberculosis active case finding through the screening of respiratory symptomatic (RS) patients at a general hospital. Methods. RS patients were defined as subjects complaining of cough and/or sputum for a period of 2 or more weeks. Outpatients and their companions were approached while they waited in the outpatient care areas of the hospital to detect RS. Two samples from different days or 2 samples taken 2 hours apart on the same day were collected. Results. 122 RS patients were identified. Fifty-seven patients (46.7%) had at least one sputum sample analyzed. Three patients presented a positive smear and 2 were culture positive; neither had upper airway symptoms. None of the patients with productive cough and upper airway symptoms had a positive smear (P = 0.07). Only 19 (33.3%) returned to the laboratory to retrieve their results. Conclusion. Current strategy to screen RS patients based only on clinical data has a low compliance. Specific strategies to increase compliance (removal of barriers, incentives, etc.) should be implemented.

Screening difficult-to-reach populations for tuberculosis using a mobile medical unit, Punjab India

“…This resulted in TB diagnosis based on clinical symptoms and CXR, a method previously reported as problematic. 19,20 Finally, there were further losses to follow-up after the diagnosis of TB was made because the linkages for treatment services could not be properly established. If TB screening and treatment are to be integrated into MMU practice, formal guidelines must be established with sufficient resource allocation to overcome these challenges.…”

Interventions to increase tuberculosis case detection at primary healthcare or community-level services

“…This study was conducted among gold mine workers, not the general population. Del Portillo‐Mustieles 2013 No community‐level intervention Delva 2016 No parallel control group den Boon 2008 No parallel control group Dholakia 2016 No community‐level interventions Dobler 2016 No community‐level interventions Eang 2012 No parallel control group Elden 2011 No parallel control group Fatima 2016 No parallel control group Fox 2012 No parallel control group Furin 2007 No parallel control group Gebi 2009 No parallel control group Gilpin 1987 No parallel control group Gonzalez‐Ochoa 2009 No parallel control group Gorbacheva 2010 No parallel control group Gounder 2011 No parallel control group Griffiths 2007 Done in low‐burden settings Hermans 2012 No community‐level intervention Hinderaker 2011a No parallel control group. This paper describes 51 individual projects that aimed to detect TB cases.…”

Cascada de atención de la tuberculosis para la población indígena en Colombia: una investigación operativa

“…Para este estudio se definieron cinco pasos: i) sintomáticos respiratorios (SR) esperados positivos (17), ii) pacientes diagnosticados con TBP, iii) pacientes que iniciaron tratamiento, iv) pacientes que completaron tratamiento, y v) pacientes que completaron tratamiento y permanecieron vivos 18 meses después. Se establecieron cuatro brechas: i) pacientes con TBP no diagnosticados, ii) pacientes que no iniciaron tratamiento, iii) pacientes con fracaso, muerte o pérdida durante el tratamiento, y iv) pacientes que fallecieron durante los primeros 18 meses posteriores a la terminación del tratamiento (cuadro 1).…”