Comparison of yield and relative costs of different screening algorithms for tuberculosis in active case-finding: a cross-section study

Abstract

Background Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China. Methods The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms. Results Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93–0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96–1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3. Conclusions Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

High non-compliance rate among presumptive tuberculosis cases referred from peripheral health facilities in silti district of Southern Ethiopia: a mixed methods study

“…National TB control programs are hence, mandated with early identification of TB cases and the prompt initiation of chemotherapy [4,5]. Relying on identification of cases through patients or clients appearing to healthcare facilities by themselves seeking care either for suggestive symptoms of TB or another service, is not effective as described in various studies [6][7][8]. Cognizant of this, the WHO included systematic screening of TB among several high-risk groups in its End TB Strategy [9] which was followed by an issuance of a guideline for prioritization of the risk groups and the screening approaches to follow [3].…”

Impact of early chest radiography on delay in pulmonary tuberculosis case notification in Ethiopia

“…Delay in the diagnosis of TB endured obstacles in Ethiopia, [ 5 ] and health facility-driven delays were frequent among smear-negative, first sought health care, and among rural. [ 5 , 18 , 19 ] A previous study showed that many patients visited several health facilities up to four rounds with a median of two before getting their final TB diagnosis [ 20 ] and there have been many challenges that contribute to the low case-finding status of the country. [ 21 , 22 ] However, evidence and recommendations on how to mitigate the delays are limited.…”