Finding the missing millions: lessons from 10 active case finding interventions in high tuberculosis burden countries

Pande, Tripti; Vasquez, Nathaly Aguilera; Cazabon, Danielle; Creswell, Jacob; Brouwer, Miranda; Ramis, Oriol; Stevens, Robert; Ananthakrishnan, Ramya; Qayyum, Shahina; Alphonsus, Chukwuka; Oga‐Omenka, Charity; Nafade, Vaidehi; Sen, Paulami

doi:10.1136/bmjgh-2020-003835

Cited by 21 publications

(30 citation statements)

References 9 publications

(9 reference statements)

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“…In summary, the potential impact of ACD on crusted scabies is not quantified from review findings, however, findings show that ACD campaigns tend to find the most missed cases of leprosy in geographically isolated and culturally marginalized communities, which aligns with evidence about ACD more generally [ 13 , 14 ]. This suggests an ACD campaign for crusted scabies in Australia may be worthwhile, given the marginalisation of remote Aboriginal communities and significant barriers to healthcare access amongst this population.…”

Section: Discussionmentioning

confidence: 98%

“…ACD is used widely in infectious disease elimination and control programs, including for skin-related neglected tropical diseases (NTDs), and is particularly important in populations facing high barriers to healthcare access such as poverty, marginalisation and/or disease stigma [ 12 ]. Campaign design and implementation impact the effectiveness of ACD, with personnel, logistics, and community buy-in being shown to be particularly important [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Active case detection methods for crusted scabies and leprosy: A systematic review

et al. 2021

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Background Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. Methods and principle findings We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. Conclusion This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Active case detection methods for crusted scabies and leprosy: A systematic review

et al. 2021

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“…Another important aspect of this intervention was that strong engagement of community leaders facilitated implementation of the intervention. Involvement of local leaders to overcome resistance in the community has been noted as an important consideration for ACF interventions [ 20 ] and has been indicated as an important step in creating effective health interventions in Nigeria [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

A Multi-Faceted Approach to Tuberculosis Active Case Finding among Remote Riverine Communities in Southern Nigeria

Eyo

Obot

Onyedinachi

et al. 2021

IJERPH

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Nigeria accounts for 11% of the worldwide gap between estimated and reported individuals with tuberculosis (TB). Hard-to-reach communities on the Southern Nigeria coast experience many difficulties accessing TB services. We implemented an active case finding (ACF) intervention in Akwa Ibom and Cross River states utilizing three approaches: house-to-house/tent-to-tent screening, community outreach and contact investigation. To evaluate the impact, we compared TB notifications in intervention areas to baseline and control population notifications, as well as to expected notifications based on historical trends. We also gathered field notes from discussions with community volunteers who provided insights on their perspectives of the intervention. A total of 509,768 individuals were screened of which 12,247 (2.4%) had TB symptoms and 11,824 (96.5%) were tested. In total, 1015 (8.6%) of those identified as presumptive had confirmed TB—98.2% initiated treatment. Following implementation, TB notifications in intervention areas increased by 112.9% compared to baseline and increased by 138.3% when compared to expected notifications based on historical trends. In contrast, control population notifications increased by 101% and 49.1%, respectively. Community volunteers indicated a preference for community outreach activities. Multi-faceted, community-based interventions in Nigeria’s coastal areas successfully increase TB detection for communities with poor access to health services.

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“…In general, compared with the health of ASMs, the health of FSWs in ASM communities remains understudied and should be a focus of future studies. Although care should be taken when extrapolating the results of this study to different settings, interviews with CHWs and community stakeholders about operational characteristics of this large ACF intervention may help to inform the design of other such interventions and may add context-specific detail to a recent study of lessons learned from other TB REACH-funded ACF interventions [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Motivation among Key Populations to Engage with Tuberculosis Screening and Testing Services in Northwest Tanzania: A Mixed-Methods Analysis

Khaji¹,

Kabwebwe²,

Mringo³

et al. 2021

IJERPH

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In northwest Tanzania, many artisanal small-scale miners (ASMs) and female sex workers (FSWs) live in informal communities surrounding mines where tuberculosis (TB) is highly prevalent. An active case finding (ACF) intervention to increase TB case notification was undertaken in two districts. Alongside this, a study was implemented to understand engagement with the intervention through: (1) quantitative questionnaires to 128 ASMs and FSWs, who either engaged or did not engage in the ACF intervention, to assess their views on TB; (2) qualitative interviews with 41 ASMs and FSWs, 36 community health workers (CHWs) and 30 community stakeholders. The mean perceived severity of TB score was higher in the engaged than in the non-engaged group (p = 0.01). Thematic analysis showed that health-seeking behaviour was similar across both groups but that individuals in the non-engaged group were more reluctant to give sputum samples, often because they did not understand the purpose. CHWs feared contracting TB on the job, and many noted that mining areas were difficult to access without transportation. Community stakeholders provided various recommendations to increase engagement. This study highlights reasons for engagement with a large-scale ACF intervention targeting key populations and presents insights from implementers and stakeholders on the implementation of the intervention.

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Finding the missing millions: lessons from 10 active case finding interventions in high tuberculosis burden countries

Cited by 21 publications

References 9 publications

Active case detection methods for crusted scabies and leprosy: A systematic review

Active case detection methods for crusted scabies and leprosy: A systematic review

A Multi-Faceted Approach to Tuberculosis Active Case Finding among Remote Riverine Communities in Southern Nigeria

Factors Affecting Motivation among Key Populations to Engage with Tuberculosis Screening and Testing Services in Northwest Tanzania: A Mixed-Methods Analysis

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