Abstract
BackgroundSince 2005, the Myanmar National Tuberculosis Programme (NTP) has been implementing active case finding (ACF) activities involving mobile teams in hard-to-reach areas. This study revealed the contribution of mobile team activities to total tuberculosis (TB) case detection, characteristics of TB patients detected by mobile teams and their treatment outcomes.MethodsThis was a descriptive study using routine programme data between October 2014 and December 2014. Mobile team activities were a one-stop service and included portable digital chest radiography (CXR) and microscopy of two sputum samples. The algorithm of the case detection included screening patients by symptoms, then by CXR followed by sputum microscopy for confirmation. Diagnosed patients were started on treatment and followed until a final outcome was ascertained.ResultsA total of 9 349 people with symptoms suggestive of TB were screened by CXR, with an uptake of 96.6%. Of those who were meant to undergo sputum smear microscopy, 51.4% had sputum examinations. Finally, 504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%. Among total cases examined by microscopy, 6.4% were sputum smear positive TB. Treatment success rate was high as 91.8% in study townships compared to national rate 85% (2014 cohort).ConclusionsThis study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts, especially when equipped with portable, digital CXR machines that provided immediate results. However, the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis. In order to optimize the ACF through mobile team activity, future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.
Highlights
Since 2005, the Myanmar National Tuberculosis Programme (NTP) has been implementing active case finding (ACF) activities involving mobile teams in hard-to-reach areas
Myanmar is a country in South-East Asia that is classified by the World Health Organization (WHO) as one of the 30 high Tuberculosis (TB) burden countries
TB screening results According to the model of ACF through mobile team used in this study, the community was announced in advance that people with symptoms suggestive of TB to come for screening of TB
Summary
Since 2005, the Myanmar National Tuberculosis Programme (NTP) has been implementing active case finding (ACF) activities involving mobile teams in hard-to-reach areas. The survey showed a higher TB prevalence (369 per 100 000 population) among ethnic minority groups in specific states [3] These states are mostly rural and hard-to-reach areas. In 2005, the programme started to implement small-scale active case finding (ACF) activities in 30 out of the 330 townships of Myanmar involving mobile team activities in those states with hard-to-reach areas. Myanmar NTP has increasingly implemented mobile team activities by using portable digital X-ray and sputum microscopy This is consistent with WHO recommended End TB Strategy which includes early diagnosis of tuberculosis and systematic screening of contacts and high risk groups as a component of first pillar: Integrated, patient-centred care and prevention [5]
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