Tuberculosis case finding using population-based disease surveillance platforms in urban and rural Kenya

Abstract

BackgroundTuberculosis (TB) case finding is an important component of TB control because it can reduce transmission of Mycobacterium tuberculosis (MTB) through prompt detection and treatment of infectious patients.MethodsUsing population-based infectious disease surveillance (PBIDS) platforms with links to health facilities in Kenya we implemented intensified TB case finding in the community and at the health facilities, as an adjunct to routine passive case finding conducted by the national TB program. From 2011 to 2014, PBIDS participants ≥15 years were screened either at home or health facilities for possible TB symptoms which included cough, fever, night sweats or weight loss in the preceding 2 weeks. At home, participants with possible TB symptoms had expectorated sputum collected. At the clinic, HIV-infected participants with possible TB symptoms were invited to produce sputum. Those without HIV but with symptoms lasting 7 days including the visit day had chest radiographs performed, and had sputum collected if the radiographs were abnormal. Sputum samples were tested for the presence of MTB using the Xpert MTB/RIF assay. TB detection rates were calculated per 100,000 persons screened.ResultsOf 11,191 participants aged ≥15 years screened at home at both sites, 2695 (23.9%) reported possible TB symptoms, of whom 2258 (83.8%) produced sputum specimens. MTB was detected in 32 (1.4%) of the specimens resulting in a detection rate of 286/100,000 persons screened. At the health facilities, a total of 11,762 person were screened, 7500 (63.8%) had possible TB symptoms of whom 1282 (17.1%) produced sputum samples. MTB was detected in 69 (5.4%) of the samples, resulting in an overall detection rate of 587/100,000 persons screened. The TB detection rate was higher in persons with HIV compared to those without at both home (HIV-infected - 769/100,000, HIV-uninfected 141/100,000, rate ratio (RR) – 5.45, 95% CI 3.25–22.37), and health facilities (HIV-infected 3399/100,000, HIV-uninfected 294/100,000, RR 11.56, 95% CI 6.18–18.44).ConclusionFacility-based intensified TB case finding detected more TB cases per the number of specimens tested and the number of persons screened, including those with HIV, than home-based TB screening and should be further evaluated to determine its potential programmatic impact.

Bundling HIV and TB Care at a District-Level Center in Sierra Leone: A high-yield method for diagnosing co-infection with TB and antiretroviral treatment failure among people living with HIV

“…Our results lend further support to the studies by Shenoi and Carmone that bundled services and checklists for HIV care are effective in closing gaps. Our results also support the body of literature showing that intensified case finding for TB within HIV clinics is acceptable to patients and improves case finding rates (Bigogo et al, 2018;Yoon et al, 2019;Owiti et al, 2019;Sawry et al, 2018;Gupta et al, 2014). Our experience is unique in that we describe an educational and programmatic way to build capacity in existing staff without added cost.…”

Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021

“…In Tanzania, which achieved a 26% reduction ( appendix 2 pp 86–149 ), the national tuberculosis programme scaled up community-based interventions aiming to link individuals to tuberculosis services with proven effectiveness 42 while introducing an effective nationwide quality-improvement initiative in tuberculosis case finding. 43 The marked progress in Cameroon 44 (30% reduction in incidence) and Kenya 45 (23% reduction in incidence; appendix 2 pp 86–149 ) might also point to the success of intensified tuberculosis case-finding programmes that were reported to increase case detection in these respective countries . In addition to these innovative case-finding programmes, many countries in sub-Saharan Africa saw marked increases in antiretroviral therapy coverage for people with HIV between 2015 and 2020 that might have further contributed to the substantial reductions in tuberculosis incidence in the region.…”

Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district

“…This is due to various factors including low TB screening and testing capacity, poor understanding of the screening protocols, inadequate knowledge by the health providers to suspect TB, low diagnostic capacities and shortages of inputs[ 9 – 11 ]. Further, the growing interest in community-based active case finding (ACF) strategies especially in resource-constrained settings has shifted the attention from [ 12 , 13 ] facility-based intensified TB case finding even though it is more cost-effective and efficient [ 14 , 15 ].…”