Abstract
BackgroundTo achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale–up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies.MethodsWe conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications.ResultsWe verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021).ConclusionsBoth salaried and volunteer CHW human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program. The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources.
Highlights
To achieve the World Health Organization (WHO) End TB Strategy targets, it is necessary to detect and treat more people with active TB early
Vo et al BMC Public Health (2020) 20:934 (Continued from previous page). Both salaried and volunteer community health workers (CHW) human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program
The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources
Summary
To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. There are 3 million annual incident TB cases globally whom these NTPs fail to reach This “detection gap” sustains transmission and mortality [4]. One strategy to close the detection gap is active case finding (ACF) [5] This has led to a global surge in ACF initiatives beyond routine household contact tracing [6, 7]. These initiatives range from facility-based systematic screening to community-based interventions among vulnerable populations [8, 9]. Better evidence on impact and cost-effectiveness is needed if they are to be sustained through national public health policies and budgets [12]
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