Implementing intensified tuberculosis case-finding among street-connected youth and young adults in Kenya

Szkwarko, Daria; Mercer, Tim; Kimani, Samuel; Braitstein, Paula; Buziba, Nathan; Carter, E. J.

doi:10.5588/pha.16.0021

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…After screening 2943 titles and abstracts and 271 full-text articles, 73 unique articles fulfilled our eligibility criteria (figure 1). 14–86 The reasons for excluding full-text articles are provided in figure 1. What all included studies have in common is the goal of finding ‘missing’ TB cases through ACF, while the approaches vary greatly; from contact investigation to screening people in homeless shelters (table 1).…”

Section: Resultsmentioning

confidence: 99%

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Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

et al. 2019

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ObjectiveTo explore antecedents, components and influencing factors on active case-finding (ACF) policy development and implementation.DesignScoping review, searching MEDLINE, Web of Science, the Cochrane Database of Systematic Reviews and the World Health Organization (WHO) Library from January 1968 to January 2018. We excluded studies focusing on latent tuberculosis (TB) infection, passive case-finding, childhood TB and studies about effectiveness, yield, accuracy and impact without descriptions of how this evidence has/could influence ACF policy or implementation. We included any type of study written in English, and conducted frequency and thematic analyses.ResultsSeventy-three articles fulfilled our eligibility criteria. Most (67%) were published after 2010. The studies were conducted in all WHO regions, but primarily in Africa (22%), Europe (23%) and the Western-Pacific region (12%). Forty-one percent of the studies were classified as quantitative, followed by reviews (22%) and qualitative studies (12%). Most articles focused on ACF for tuberculosis contacts (25%) or migrants (32%). Fourteen percent of the articles described community-based screening of high-risk populations. Fifty-nine percent of studies reported influencing factors for ACF implementation; mostly linked to the health system (eg, resources) and the community/individual (eg, social determinants of health). Only two articles highlighted factors influencing ACF policy development (eg, politics). Six articles described WHO’s ACF-related recommendations as important antecedent for ACF. Key components of successful ACF implementation include health system capacity, mechanisms for integration, education and collaboration for ACF.ConclusionWe identified some main themes regarding the antecedents, components and influencing factors for ACF policy development and implementation. While we know much about facilitators and barriers for ACF policy implementation, we know less about how to strengthen those facilitators and how to overcome those barriers. A major knowledge gap remains when it comes to understanding which contextual factors influence ACF policy development. Research is required to understand, inform and improve ACF policy development and implementation.

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Section: Resultsmentioning

confidence: 99%

“…† Letter to editor,52 observational study,53 perspective33 and editorial 47‡ Population affected by TB outbreak,72 pastoralists,41 healthcare workers,65 prisoners,80 people living in slums,86 street connected youth and young adults85 and non-immigrant visitors 70…”

Section: Methodsmentioning

confidence: 99%

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

et al. 2019

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“…It does not compare a TB case‐finding intervention with no intervention. Shrivastava 2012 No parallel control group Soares 2013 No parallel control group Ssemmondo 2016 No parallel control group Story 2012 No parallel control group Szkwarko 2016 No parallel control group Uwimana 2012 No outcomes relevent to this review Wei 2015 No community‐level intervention. This study was done in smokers.…”

Section: Characteristics Of Excluded Studies [Ordered By Study Id]mentioning

confidence: 99%

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

Mhimbira

Cuevas

Dacombe

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundPulmonary tuberculosis is usually diagnosed when symptomatic individuals seek care at healthcare facilities, and healthcare workers have a minimal role in promoting the health-seeking behaviour. However, some policy specialists believe the healthcare system could be more active in tuberculosis diagnosis to increase tuberculosis case detection.ObjectivesTo evaluate the effectiveness of different strategies to increase tuberculosis case detection through improving access (geographical, financial, educational) to tuberculosis diagnosis at primary healthcare or community-level services.Search methodsWe searched the following databases for relevant studies up to 19 December 2016: the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library, Issue 12, 2016; MEDLINE; Embase; Science Citation Index Expanded, Social Sciences Citation Index; BIOSIS Previews; and Scopus. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the metaRegister of Controlled Trials (mRCT) for ongoing trials.Selection criteriaRandomized and non-randomized controlled studies comparing any intervention that aims to improve access to a tuberculosis diagnosis, with no intervention or an alternative intervention.Data collection and analysisTwo review authors independently assessed trials for eligibility and risk of bias, and extracted data. We compared interventions using risk ratios (RR) and 95% confidence intervals (CI). We assessed the certainty of the evidence using the GRADE approach.Main resultsWe included nine cluster-randomized trials, one individual randomized trial, and seven non-randomized controlled studies. Nine studies were conducted in sub-Saharan Africa (Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe), six in Asia (Bangladesh, Cambodia, India, Nepal, and Pakistan), and two in South America (Brazil and Colombia); which are all high tuberculosis prevalence areas.Tuberculosis outreach screening, using house-to-house visits, sometimes combined with printed information about going to clinic, may increase tuberculosis case detection (RR 1.24, 95% CI 0.86 to 1.79; 4 trials, 6,458,591 participants in 297 clusters, low-certainty evidence); and probably increases case detection in areas with tuberculosis prevalence of 5% or more (RR 1.52, 95% CI 1.10 to 2.09; 3 trials, 155,918 participants, moderate-certainty evidence; prespecified stratified analysis). These interventions may lower the early default (prior to starting treatment) or default during treatment (RR 0.67, 95% CI 0.47 to 0.96; 3 trials, 849 participants, low-certainty evidence). However, this intervention may have may have little or no effect on treatment success (RR 1.07, 95% CI 1.00 to 1.15; 3 trials, 849 participants, low-certainty evidence), and we do not know if there is an effect on treatment failure or mortality. One study investigated long-term prevalence in the community, but with no clea...

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“…72 , 73 However, tuberculosis services have generally not yet been tailored to adolescent needs, 74 , 75 and our review identified only two studies that provided adolescent-centred services. 49 , 52 …”

Section: Discussionmentioning

confidence: 99%

Tuberculosis care models for children and adolescents: a scoping review

Yuen¹,

Szkwarko²,

Dubois³

et al. 2022

Bull World Health Org

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Objective To map which tuberculosis care models are best suited for children and adolescents. Methods We conducted a scoping review to assess the impact of decentralized, integrated and family-centred care on child and adolescent tuberculosis-related outcomes, describe approaches for these care models and identify key knowledge gaps. We searched seven literature databases on 5 February 2021 (updated 16 February 2022), searched the references of 18 published reviews and requested data from ongoing studies. We included studies from countries with a high tuberculosis burden that used a care model of interest and reported tuberculosis diagnostic, treatment or prevention outcomes for an age group < 20 years old. Findings We identified 28 studies with a comparator group for the impact assessment and added 19 non-comparative studies to a qualitative analysis of care delivery approaches. Approaches included strengthening capacity in primary-level facilities, providing services in communities, screening for tuberculosis in other health services, co-locating tuberculosis and human immunodeficiency virus treatment, offering a choice of treatment location and providing social or economic support. Strengthening both decentralized diagnostic services and community linkages led to one-to-sevenfold increases in case detection across nine studies and improved prevention outcomes. We identified only five comparative studies on integrated or family-centred care, but 11 non-comparative studies reported successful treatment outcomes for at least 71% of children and adolescents. Conclusion Strengthening decentralized services in facilities and communities can improve tuberculosis outcomes for children and adolescents. Further research is needed to identify optimal integrated and family-centred care approaches.

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Implementing intensified tuberculosis case-finding among street-connected youth and young adults in Kenya

Cited by 8 publications

References 10 publications

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

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

Tuberculosis care models for children and adolescents: a scoping review

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