Mobilising elementary and secondary school students for tuberculosis case finding in Anhui, China

Abstract

study to assess project implementation and case fi nding of new smear-positive TB during the FIDELIS project, and report the results of this study. METHODS Anhui ProvinceAnhui Province has a land mass of 139 000 km 2 Activities of the FIDELIS Anhui ProjectThe core activity of the FIDELIS Anhui Project was to mobilise students of elementary and junior high schools to identify individuals who might have TB within the family. A 3-page survey card was designed for this purpose ( Figure). The fi rst page collected basic information on the student's family, whether any family member had had TB in the past and whether any family member had a cough or had produced sputum for ⩾3 weeks. The second page indicated that those who had a cough or had produced sputum for ⩾3 weeks might have TB, and that free services were provided at the county TB dispensaries. The third page was for students to write down their weekly class schedule so that they could keep the survey card with the message of TB.Teachers provided health education on TB before distributing the survey cards, and collected them within a week of distribution. Survey cards identifying symptomatic individuals were sent by the teachers to the village doctors, who were trained to visit individuals with symptoms and, if necessary, advise them to submit sputum to the township health centres for examination. Three sputum samples were collected from each symptomatic individual. Sputum smear was prepared at the township hospital and read at county TB dispensaries. Confi rmed TB patients were registered for anti-tuberculosis treatment according to national TB guidelines. 12 Design: A survey card was designed for students to identify individuals who might have tuberculosis (TB) in their family. Teachers provided health education on TB before distributing the survey cards. Survey cards identifying individuals with respiratory symptoms for ⩾3 weeks were sent by the teachers to village doctors who were trained to visit symptomatic individuals and advise them to undergo sputum examination. Data were routinely collected in the implementation of the FIDELIS project, and quarterly reports from the National Tuberculosis Programme were analysed. The detection of new smear-positive TB cases before and after FIDELIS, as well as with and without FIDELIS, were compared. Interna onal Union Against Tuberculosis and Lung Disease Results:In the first year, a total of 2 387 405 students were involved and 23 079 symptomatic individuals were examined, among whom 2307 (10.3%) were diagnosed with smear-positive TB. Case detection in FIDELIS counties increased by a factor of 3.5 during the FIDELIS period compared with before FIDELIS, and that in non-FIDELIS counties by a factor of 3.1 (P = 0.001). Conclusion:It was feasible to massively mobilise students for TB case finding through collaboration between the health care and education systems.

Impact of awareness drives and community-based active tuberculosis case finding in Odisha, India

“…3 In a study conducted under the FIDELIS (Fund for Innovative DOTS Expansion through Initiatives to Stop TB) project involving elementary and secondary students in Anhui, China, case detection in targeted counties increased by a factor of 3.5 during the project period. 4 While our approach showed potential for improved case detection in the short term, we do not know if these gains will be sustained long term. Furthermore, we did not collect data to show if the approach led to earlier detection and thereby reduced transmission or improved treatment outcomes for patients, which are the ultimate goals of ACF.…”

Community-based active case-finding interventions for tuberculosis: a systematic review

“…Of the 28 studies, five were done in general populations, 11,[16][17][18]25 seven were done in high-density, low-income urban areas, 10,19,23,[26][27][28]32 two were done in camps for internally displaced people, 20,21 four were done in remote rural populations, 8,9,22,35 four were done among indigenous populations (two of which were also in high-density, low-income urban areas), 19,24,26,29 four were done in prisons, 13,30,33,34 one was done in gold mines, 12 and two were done among people experiencing homelessness. 14,15 Several types of active case-finding intervention were used and some studies used more than one (tables 1-3, appendix pp 2-7).…”

“…We did a systematic search of PubMed, Embase, Scopus, and Cochrane Library for papers published between Nov 1, 2010, and Feb 14, 2019 (subsequently updated to April 13, 2020). The search terms used are described in the appendix (pp [15][16].…”

Challenges to the global control of tuberculosis

“…In settings where patient delay in seeking care is long, outreach activities might be useful to increase TB case finding. This is illustrated in an innovative intervention undertaken in Anhui Province in China supported by the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB initiative . More than 2 million students were mobilized to encourage those with symptoms suggestive of TB to present for examination for TB with 2307 cases detected, significantly greater than the number identified in counties where the project had not been implemented.…”

“…This is illustrated in an innovative intervention undertaken in Anhui Province in China supported by the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB initiative. 62 More than 2 million students were mobilized to encourage those with symptoms suggestive of TB to present for examination for TB with 2307 cases detected, significantly greater than the number identified in counties where the project had not been implemented. Innovative interventions to increase TB case finding are likely context-dependent; social mobilization and information, education and communication; semiactive case finding; innovative approaches for microscopy services; health system strengthening; and use of incentives have been shown to increase case finding in various settings.…”