Abstract
Tuberculosis screening programs commonly target areas with high case notification rates. However, this may exacerbate disparities by excluding areas that already face barriers to accessing diagnostic services. We compared historic case notification rates, demographic, and socioeconomic indicators as predictors of neighborhood-level tuberculosis screening yield during a mobile screening program in 74 neighborhoods in Lima, Peru. We used logistic regression and Classification and Regression Tree (CART) analysis to identify predictors of screening yield. During February 7, 2019–February 6, 2020, the program screened 29,619 people and diagnosed 147 tuberculosis cases. Historic case notification rate was not associated with screening yield in any analysis. In regression analysis, screening yield decreased as the percent of vehicle ownership increased (odds ratio [OR]: 0.76 per 10% increase in vehicle ownership; 95% confidence interval [CI]: 0.58–0.99). CART analysis identified the percent of blender ownership (≤ 83.1% vs > 83.1%; OR: 1.7; 95% CI: 1.2–2.6) and the percent of TB patients with a prior tuberculosis episode (> 10.6% vs ≤ 10.6%; OR: 3.6; 95% CI: 1.0–12.7) as optimal predictors of screening yield. Overall, socioeconomic indicators were better predictors of tuberculosis screening yield than historic case notification rates. Considering community-level socioeconomic characteristics could help identify high-yield locations for screening interventions.
Highlights
Tuberculosis screening programs commonly target areas with high case notification rates
We ran sensitivity analyses, removing each of the potentially influential observations one by one, and found that removal of one of the three neighborhoods substantially reduced the strength of several of the observed associations. This observation was a neighborhood with a 12% TB screening yield; 3 individuals were diagnosed with TB disease out of only 25 people screened
We found that historic case notification rates were not good predictors of the yield of TB diagnoses among residents of communities served by a mobile TB screening program in Lima, Peru
Summary
Tuberculosis screening programs commonly target areas with high case notification rates. We compared historic case notification rates, demographic, and socioeconomic indicators as predictors of neighborhood-level tuberculosis screening yield during a mobile screening program in 74 neighborhoods in Lima, Peru. Socioeconomic indicators were better predictors of tuberculosis screening yield than historic case notification rates. Without active case-finding, many individuals with TB disease may experience missed or delayed diagnoses because they do not perceive symptoms and do not seek care, because they face barriers accessing health facilities, or because health facilities rely on sputum smear microscopy, which has low sensitivity[5]. We explored whether neighborhood-level demographic or socioeconomic indicators predicted the yield of TB diagnoses among screened individuals better than historic case notification rates
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