Journal
BULLETIN OF THE WORLD HEALTH ORGANIZATION
Volume 96, Issue 8, Pages 522-530Publisher
WORLD HEALTH ORGANIZATION
DOI: 10.2471/BLT.17.203968
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Funding
- Stop TB partnership's TB Reach initiative
- Government of Canada
- Bill & Melinda Gates Foundation
- United States Agency for International Development (Challenge TB)
- Innoviris, Brussels, Belgium
- Joint Global Health Trials consortium
- Medical Research Centre
- Department for International Development
- Wellcome Trust
- Innovation for Health and Development
- MRC [MR/K007467/1] Funding Source: UKRI
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Objective To investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic of the Congo, especially among groups at high risk of tuberculosis infection. Methods To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselves received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the intervention (2014-2016). Findings Acceptability of the intervention was high.Volunteers screened 650434 individuals in their communities, 73418 of whom reported a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing.Tuberculosis was diagnosed in 1 in 151 people screened, costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with poorer access to health care represented only 5.1% (33002/650 434) of those screened, they contributed 19.7% (845/4300) of tuberculosis diagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% (4 300/10 247) of the provincial total for that period. Conclusion Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used to assist health systems in the elimination of tuberculosis.
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