Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study

Kazibwe, Andrew; Twinomugisha, Fred; Musaazi, Joseph; Nakaggwa, Florence; Lukanga, Disan; Aleu, Phillip; Kiyemba, Timothy; Nkolo, Abel; Kirirabwa, Nicholas Sebuliba; Lopez, Debora B. Freitas; Birabwa, Estella; Dejene, Seyoum; Zawedde‐Muyanja, Stella

doi:10.4314/ahs.v21i3.3

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…In addition, the result from this study reported a higher NNS of 5402 ((95% CI: 5347–6526) in Maternal Child Health (MCH). The findings are consistent with a similar study conducted in Kampala that reported a higher NNS of 8410 in the MCH [ 42 ]. Higher NNS in MCH could point to the quality of TB screening, which calls for implementers and managers in MCH to strengthen screening quality in this area.…”

Section: Discussionsupporting

confidence: 93%

“…The screening yield was different among females and males in both HCI at 5.5% (55/1000) in females, and males, 6.0% (60/1000) P <0.01, and in PCF at 0.28 (280/100000) in females and males at 1.12 (1200/100000) P <0.01. The higher screening yield among men in both strategies is consistent with findings from several TB prevalence surveys and studies that report a higher prevalence of TB among men [ 42 , 43 ]. It could be because men are sometimes more exposed to predisposed factors like alcohol and smoking.…”

Section: Discussionsupporting

confidence: 87%

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Cost-effectiveness analysis of adding tuberculosis household contact investigation on passive case-finding strategy in Southwestern Uganda

Odongo,

Omech,

Acanga

2023

PLoS ONE

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Introduction The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of Tuberculosis. A household contact investigation is an alternative approach. However, there is limited cost-effectiveness data to support planning and implementation in low and middle-income countries. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HCI) to the passive case-finding (PCF) strategy in the Tuberculosis control program in Southwestern Uganda. Methods We conducted an economic evaluation using a retrospective study approach and bottom-up costing (ingredients) techniques. It was a synthesis-based evaluation of existing data extracted from the District Health Information System (DHIS 2), TB registers, and a primary cost survey. The study compared two methods of Tuberculosis (TB) case finding (PCF and HCI) strategies. Regarding PCF, patients either self-reported their signs and symptoms or were prompted by healthcare workers. At the same time, HCI was done by home visiting and screening contacts of TB patients. Patients and household contacts presumed to have Tuberculosis were requested to produce samples for analysis. We applied a static decision-analytic modeling framework to examine both strategies’ costs and effectiveness. The study relied on cost and probability estimates from National Tuberculosis (TB) program data, activity costs, and published literature. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntungamo, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients screened during the period under study. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. We did not apply a discount rate because of the short analytic time horizon. Results The unit costs of detecting a Tuberculosis case were US$ (United States dollar) 204.22 for PCF and US$ 315.07 for HCI. Patient and caregiver costs are five times more in PCF than in HCI [US$26.37 Vs. US$ 5.42]. The ICER was US$ 3,596.94 per additional TB case detected. The TB screening yields were 0.52% (1496/289140) for passive case finding and 5.8% (197/3414) for household contact investigation. Household contact investigation yield among children 0–14 Vs. 15+ years [6.2% Vs.5.4%] P = 0.04. The Yield among People living with HIV (PLHIV) Vs. HIV-negative [15.8% Vs.5.3%] P = 0.03 in HHCI. The PCF yield in men Vs. Women [1.12% Vs.0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186–294] and 17 [95% CI: 14–22] in HCI. Conclusion Our baseline assumptions and the specific implementations of adding HCI to existing PCF programs in the context of rural African settings prove to be not cost-effective, rather than HCI as a strategy. HCI effectively identifies children and PLHIV with TB and should be prioritized. Meanwhile, the Passive case-finding strategy effectively finds men with TB and costs lower than household contact investigation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 87%

Cost-effectiveness analysis of adding tuberculosis household contact investigation on passive case-finding strategy in Southwestern Uganda

Odongo,

Omech,

Acanga

2023

PLoS ONE

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“…One intervention for TB-HIV co-infection found that community-based TB screening increased screening efforts but decreased presumed TB and TB positive cases identified. 45…”

Section: Resultsmentioning

confidence: 99%

“…One intervention for TB-HIV co-infection found that community-based TB screening increased screening efforts but decreased presumed TB and TB positive cases identified. 45 There were a total of 39 community service interventions focused on HIV testing -17 interventions distributed HIVST to men (primary or secondary distribution), [46][47][48][49][50][51][52][53][54][55][56][57][58] 15 provided community/workforce testing (non-HIVST), 52,53,55,[59][60][61][62][63][64][65][66][67][68][69][70][71] and 11 provided home-based HIV testing services. 46,54,61,69,[72][73][74][75] Community services outperformed standard of care facility services 48,52,60,61,65,67,72,73 and mobile and targeted venue testing such as work were more cost...…”

Section: Community Servicesmentioning

confidence: 99%

Interventions to improve men’s engagement in HIV and other key services in sub-Saharan Africa: a scoping review

Dovel,

Hubbard,

Zembe

et al. 2023

Preprint

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Background Men in sub-Saharan Africa (SSA) continue to have worse health outcomes across HIV, STI and TB-HIV co-infections as compared to women. Improving service coverage is critical for population health and HIV epidemic control. In HIV, for example, recent models show that improving mens HIV testing and treatment coverage could reduce HIV incidence among women in the region by half. There is potential to combine and optimize services across HIV, STI and TB-HIV co-infections, yet little is known about effective interventions to improve mens outcomes across health services. Methods We conducted a scoping review of interventions to understand what interventions work for men, and any synergies in interventions that work across health services. We specifically focused on interventions aimed to improve service utilization in the following service domains: condom use; pre-exposure prophylaxis (PrEP); STI testing and treatment; HIV testing, initiation, and retention; and TB testing and treatment among those living with HIV (co-infected). Articles and abstracts had to include sex disaggregated data or solely focus on mens health service outcomes. We searched PubMed, Medline, Cochrane Central Register of Controlled Trials, the CABI Global Health databases and major international conference abstracts. We included studies from SSA, published between January 1, 2009 to Dec 31, 2022, quantitative data on at least one of the selected service domains, disaggregated data for the general male population (not solely key populations), an intervention study (report outcomes for at least one non-standard service delivery strategy) with a comparison group, and available in English. We describe the type of interventions evaluated and synthesize overarching themes of what works for reaching men. Findings We identified 15,595 intervention articles and included 71 in the scoping review, representing 109 unique interventions. Over a quarter of interventions targeted male partners and only 7 exclusively targeted men. Nearly half of interventions had HIV testing as their primary outcome. Only a handful of interventions included outcomes related to condom use, STI or TB co-infection services. No interventions examined the effect on PrEP use among general male populations. Community services were the most common interventions tested 38% of all interventions), followed by community outreach (n=19; 17%) and incentives (n=16; 15%) and facility services (n=15, 14%). Counseling and peer support had the least number of interventions evaluated (n=8, 7%). We were unable to identify cross-cutting strategies to reach men across HIV and related health services in sub-Saharan Africa, largely because there is little evidence outside HIV testing interventions. The limited evidence available points to the fact that men need convenient, actively reached out to men as clients, and improved mens experiences with health services. The same principles may be apply to all services intended to reach men, including sexual health and TB co-infection services, although the evidence is limited. Conclusion This review highlights the need for additional research on cross-cutting strategies to improve mens engagement in HIV and related health services. The limited evidence available suggests that convenient services, actively engaging men, and providing positive experiences with health services largely improve service utilization. Additional evidence is needed for PrEP use and non-HIV services (such as STI and TB co-infection).

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“…The first TB paper is by Laura Madukaji and colleagues from Nigeria. They report on “Early detection of Pre-XDR TB with line probe assay in a high TB burden country.” 1 This is followed by a paper from Uganda, in which Andrew Kazibwe and colleagues report on “the yield of different active TB case finding interventions in a large urban TB project, in central Uganda.” 2 . They describe the comparative yield of three active case finding interventions: “health facility-based screening, targeted community screening; and household contact tracing.” They discuss the merits and demerits of the different approaches.…”

mentioning

confidence: 99%

Editorial: TB on the rise: but researchers are not sleeping

Tumwine¹

2021

Afr H. Sci.

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Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study

Cited by 3 publications

References 15 publications

Cost-effectiveness analysis of adding tuberculosis household contact investigation on passive case-finding strategy in Southwestern Uganda

Cost-effectiveness analysis of adding tuberculosis household contact investigation on passive case-finding strategy in Southwestern Uganda

Interventions to improve men’s engagement in HIV and other key services in sub-Saharan Africa: a scoping review

Editorial: TB on the rise: but researchers are not sleeping

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