Abstract
BackgroundPakistan implemented initiatives to detect tuberculosis (TB) patients through extended contact screening (ECS); it improved case detection but treatment outcomes need assessment. ObjectivesTo compare treatment outcomes of pulmonary TB (PTB) patients detected by ECS with those detected by routine passive case finding (PCF). MethodsA cohort study using secondary program data conducted in Lahore, Faisalabad and Rawalpindi districts and Islamabad in 2013–15. We used log binomial regression models to assess if ECS was associated with unfavorable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) after adjusting for potential confounders. ResultsWe included 79,431 people with PTB; 4604 (5.8%) were detected by ECS with 4052 (88%) bacteriologically confirmed. In all PTB patients the proportion with unfavorable outcomes was not significantly different in ECS group (9.6%) compared to PCF (9.9%), however, among bacteriologically confirmed patients unfavorable outcomes were significantly lower in ECS (9.9%) than PCF group (11.6%, P = 0.001). ECS was associated with a lower risk of unfavorable outcomes (adjusted relative risk (aRR) 0.90; 95% CI 0.82–0.99) among ‘all PTB’ patients and bacteriologically confirmed PTB patients (aRR 0.91; 95% CI 0.82–1.00). ConclusionIn PTB patients detected by ECS the treatment outcomes were not inferior to those detected by PCF.
Highlights
Pakistan has a high burden of tuberculosis (TB) with an estimated 5,70,000 incident TB patients and 42,000 deaths in 2019; only 58% of the estimated patients were diagnosed, notified and started on treatment (World Health Organization, 2020a)
The majority of the case finding is through the public sector (National Tuberculosis Programme, 2019b) where people with presumptive TB come to a public health facility and are investigated for TB; this is called “passive case finding” (PCF) and the initiative comes from the patients
In this large study from 4 districts of Pakistan, we found that the treatment outcomes among pulmonary TB (PTB) patients detected by extended contact screening (ECS) were similar to those detected by PCF
Summary
Pakistan has a high burden of tuberculosis (TB) with an estimated 5,70,000 incident TB patients and 42,000 deaths in 2019; only 58% of the estimated patients were diagnosed, notified and started on treatment (World Health Organization, 2020a). The majority of the case finding is through the public sector (National Tuberculosis Programme, 2019b) where people with presumptive TB come to a public health facility and are investigated for TB; this is called “passive case finding” (PCF) and the initiative comes from the patients. Often such patients are referred by the private health sector where diagnostic services are not available. Pakistan implemented initiatives to detect tuberculosis (TB) patients through extended contact screening (ECS); it improved case detection but treatment outcomes need assessment.
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