Feasibility of two active case finding approaches for detection of tuberculosis in Bandung City, Indonesia

Abstract

A community health clinic catchment area in the eastern part of Bandung City, Indonesia. To evaluate the feasibility of two different screening interventions using community health workers (CHWs) in detecting tuberculosis (TB) cases. This was a feasibility study of 1) house-to-house TB symptom screening of five randomly selected 'neighbourhoods' in the catchment area, and 2) selected screening of household contacts of TB index patients and their neighbouring households. Acceptability was assessed through focus group discussions with key stakeholders. Of 5100 individuals screened in randomly selected neighbourhoods, 48 (0.9%) reported symptoms, of whom 38 provided sputum samples; no positive TB was found. No TB cases were found among the 88 household contacts or the 423 neighbourhood contacts. With training, regular support and supervision from research staff and local community health centre staff, CHWs were able to undertake screening effectively, and almost all householders were willing to participate. The use of CHWs for TB screening could be integrated into routine practice relatively easily in Indonesia. The effectiveness of this would need further exploration, particularly with the use of improved diagnostics such as chest X-ray and sputum culture.

Implementation status of household contact tuberculosis screening by health extension workers: assessment findings from programme implementation in Tigray region, northern Ethiopia

“…Early detection helps to reduce the risks of TB transmission, poor treatment outcomes, undesirable health sequelae, and adverse social and economic consequences of the disease [12]. Studies have shown that community-based systematic screening of HH contacts is feasible and can contribute to improve TB cases finding [13][14][15][16], but it is not practiced in many high burden countries [17].…”

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“…Extraordinary efforts are required to achieve the target of hundred-thousand inoculation per day and increase the number of healthcare staff up to more than seven times the current number within a limited, tight time. One plausible strategy is the involvement of community health workers who are familiar with child vaccination or tuberculosis program [ 15 ]. In low- and middle-income countries, the problem is beyond the healthcare staff availability.…”

Are neighbourhoods of tuberculosis cases a high-risk population for active intervention? A protocol for tuberculosis active case finding

“…However, we now know that in most high burden settings, the majority of Mycobacterium tuberculosis (Mtb) transmission occurs in the community where there are vastly greater numbers of human encounters [5] that often share socio-economic risk factors that are correlated with TB [6,7]. In a feasibility study in Bandung, Indonesia [8] we followed individual TB patients back to their communities. We found an incidence rate of self-reported TB of 649 per 100,000/year in TB household contacts, 675 in neighbouring households, and 325 in randomly selected neighbourhoods [8].…”

“…In a feasibility study in Bandung, Indonesia [8] we followed individual TB patients back to their communities. We found an incidence rate of self-reported TB of 649 per 100,000/year in TB household contacts, 675 in neighbouring households, and 325 in randomly selected neighbourhoods [8].…”