Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding

A O Adejumo,O J Daniel,E Klinkenberg,O Okorie,O M Lawal,J C Okeibunor,O J Onazi,B Azuogu,E M H Mitchell,M Gidado

doi:10.1186/s12889-016-2769-7

Abstract

BackgroundEngagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited.MethodsWe compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral.ResultsCWs referred 4–22 % of presumptive TB clients tested, and 4–24 % of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables.ConclusionAll community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Highlights

Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy
The Local Government Areas (LGAs) is the operational level of the National Tuberculosis and Leprosy Control Programme (NTBLCP)
Sample characteristics A total of 115 community workers (CWs) were recruited into the study

Summary

Introduction

Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. In order to fund CTBC activities in the country, the National Tuberculosis and Leprosy Control Programme (NTBLCP) embraced collaboration with implementing partners. Many of the implementing partners work through Community Based Organizations (CBOs) in the selection, training and supervision of the CWs. In addition to referral of presumptive TB cases to the DOTS centres, in some models CWs serve as treatment supporters and help track those lost to follow up. Each implementing partner adopted a slightly different approach (which we refer to as models) in their CTBC operations. The models vary in mode of recruitment, frequency and method of supervision and motivation of workers, record keeping, level and regularity of compensation, and whether referral quotas were explicitly set (Tables 1 and 2)

Methods

Results

Conclusion