Journal
TROPICAL MEDICINE AND INFECTIOUS DISEASE
Volume 6, Issue 2, Pages -Publisher
MDPI
DOI: 10.3390/tropicalmed6020050
Keywords
active case finding; TB yield rate; ACF strategies; ACF interventions; GeneXpert; Nepal
Categories
Funding
- Stop TB Partnership/UNOPS-TB REACH project [5-31]
- European Union, Horizon 2020-IMPACT TB project [733174]
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By comparing the yield of tuberculosis active case finding interventions and diagnostic methods, it was found that screening at hospital OPD yielded the highest number of cases, and the positivity rate using GeneXpert was significantly higher than smear microscopy, indicating a more effective case-finding approach.
This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening of social contacts of known index cases, TB camps in remote areas, and screening for hospital out-patient department (OPD) attendees. Symptomatic individuals were then tested using smear microscopy or GeneXpert MTB/RIF as first diagnostic test. Yield rates were compared for each intervention and diagnostic method. We evaluated additional cases notified from ACF interventions by comparing case notifications of the intervention and control districts using standard TB REACH methodology. The project identified 1092 TB cases. The highest yield was obtained from OPD screening at hospitals (n = 566/1092; 52%). The proportion of positive tests using GeneXpert (5.5%, n = 859/15,637) was significantly higher than from microscopy testing 2% (n = 120/6309). (OR = 1.4; 95%CI = 1.12-1.72; p = 0.0026). The project achieved 29% additionality in case notifications in the intervention districts demonstrating that GeneXpert achieved substantially higher case-finding yields. Therefore, to increase national case notification for TB, Nepal should integrate OPD screening using GeneXpert testing in every district hospital and scale up of community-based ACF of TB patient contacts nationally.
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