Abstract
Active case finding (ACF) for tuberculosis (TB) was implemented in 60 selected high TB burden wards of Kolkata, India. Community volunteers called TOUCH (Targeted Outreach for Upliftment of Community Health) agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the “care cascade” of PTBPs that were identified during July to December 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. An explanatory mixed-methods study with a quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Of the 3,86242 individuals that were enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited a referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%). The number needed to screen for one TB patient was 2183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage losses for attending health facilities, and substance abuse among PTBPs. The yield of ACF was suboptimal with low PTBP identification rate and a high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.
Highlights
Tuberculosis (TB) remains a major public health problem, with an estimated 10 million TB patients and 1.6 million deaths globally due to TB in the year 2017 [1]
We aimed to explore the challenges in implementing the Active case finding (ACF) activity as perceived by TOUCH agent (TA) and presumptive TB patients (PTBPs)
Of the total 386,242 individuals who were enumerated by TAs from 92,294 houses, 1132 (0.3%)
Summary
Tuberculosis (TB) remains a major public health problem, with an estimated 10 million TB patients and 1.6 million deaths globally due to TB in the year 2017 [1]. Only 6.7 million TB patients were referred to national TB programs (NTP) [1]. India alone has an estimated 0.8 million patients who were not referred to NTP [1]. TB patients who go undetected or are not treated can be a potential threat to TB control efforts as they contribute to uninterrupted transmission of the disease. One of the potential reasons for undetected TB patients is over reliance on passive case finding for diagnosis of TB in low- and middle-income countries (LMICs) [2,3]
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