Abstract
The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This process is complicated by significant gaps in knowledge regarding mass screening. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing service. The study was conducted at a mobile HIV testing service operating in deprived communities in Cape Town, South Africa. All HIV-negative individuals with symptoms suggestive of tuberculosis, and all HIV-positive individuals regardless of symptoms were eligible for participation and referred for sputum induction. Samples were examined by microscopy and culture. Active tuberculosis case finding was conducted on 181 days at 58 different sites. Of the 6,309 adults who accessed the mobile clinic, 1,385 were eligible and 1,130 (81.6%) were enrolled. The prevalence of smear-positive tuberculosis was 2.2% (95% CI 1.1-4.0), 3.3% (95% CI 1.4-6.4), and 0.4% (95% CI 1.4 015-6.4) in HIV-negative individuals, individuals newly diagnosed with HIV, and known HIV, respectively. The corresponding prevalence of culture-positive tuberculosis was 5.3% (95% CI 3.5-7.7), 7.4% (95% CI 4.5-11.5), 4.3% (95% CI 2.3-7.4), respectively. Of the 56 new tuberculosis cases detected, 42 started tuberculosis treatment and 34 (81.0%) completed treatment. The cost of the intervention was US$1,117 per tuberculosis case detected and US$2,458 per tuberculosis case cured. The generalisability of the study is limited to similar settings with comparable levels of deprivation and TB and HIV prevalence. Mobile active tuberculosis case finding in deprived populations with a high burden of HIV and tuberculosis is feasible, has a high uptake, yield, and treatment success. Further work is now required to examine cost-effectiveness and affordability and whether and how the same results may be achieved at scale.
Highlights
Mobile active tuberculosis case finding in deprived populations with a high burden of HIV and tuberculosis is feasible, has a high uptake, yield, and treatment success
Active tuberculosis (TB) case finding in HIV-infected individuals has been recommended by the World Health Organization (WHO) as part of the ‘‘Three I’s’’ policy initiative [1,2]
We report the results of a study investigating the feasibility, uptake, treatment outcomes, and cost of adding an active TB casefinding program linked to an existing mobile HIV testing service in Cape Town, South Africa
Summary
Active tuberculosis (TB) case finding in HIV-infected individuals has been recommended by the World Health Organization (WHO) as part of the ‘‘Three I’s’’ policy initiative [1,2]. The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing service. In 2010, 8.8 million people developed active tuberculosis—a contagious bacterial infection—and 1.4 million people died from the disease Most of these deaths were in low- and middle-income countries and a quarter were in HIV-positive individuals—people who are infected with HIV, the virus that causes AIDS, are susceptible to tuberculosis because of their weakened immune system. Tuberculosis can be cured by taking several powerful antibiotics daily for at least 6 months
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