Abstract
There was an estimated 20-40% decline in tuberculosis (TB) case detection in the South-East Asia Region (SEA Region) during 2020 due to COVID-19 outbreak. This is over and above a million people with TB who were missed each year, prior to the pandemic. Active case finding (ACF) for TB has been gaining considerable interest and investment in the SEA Region and will be even more essential for finding people with TB missed due to the COVID-19 pandemic. Many countries in the Region have incorporated ACF activities into national strategic plans and are conducting large scale activities with varying results. ACF can reach people with TB earlier than routine approaches, can lead to increases in the numbers of people diagnosed, and is often needed for certain key populations who face stigma, social, and economic barriers. However, ACF is not a one size fits all approach, and has higher costs than routine care. So, planning interventions in consultation with relevant stakeholders including the affected communities is critical. Furthermore, continuous monitoring during the intervention and after completion is crucial as national TB programmes review progress and decide on the effective utilization of limited resources. Planning and monitoring become more relevant in the COVID-19 era because of constraints posed by resource diversion towards pandemic control. Here, we summarize different aspects of planning and monitoring of ACF approaches to inform national TB programmes and partners based on experiences in the SEA Region, as programmes look to reach those who are missed and catch-up on progress towards ending TB.
Highlights
The South-East Asia Region (SEA Region) of the World Health Organization (WHO) has the highest tuberculosis (TB) burden among all six WHO Regions
The ongoing COVID-19 pandemic has revealed the fragility of the gains made by the national TB programmes and highlighted the need for active outreach to diagnose people who are missed by the routine systems
As an immediate priority during COVID-19 and post pandemic era, considerable focus will be required on active case finding (ACF) while keeping in mind the required efficiency because of diversion of human and financial resources towards addressing the pandemic [65]
Summary
The South-East Asia Region (SEA Region) of the World Health Organization (WHO) has the highest tuberculosis (TB) burden among all six WHO Regions. Other activities that improved the cost-efficiency and improved monitoring, linkage to care and reporting included the use of digital system for recording patient data and to coordinate between screening, diagnosis and treatment initiation, and integrating ACF activities for TB with other health programmes to optimize resources. When the outreach efforts have been completed in a given area or time, other indicators can be considered, to inform NTP planning including epidemiological and programme reviews, (for assessing the epidemiological impact if any and costs), and to provide feedback to communities where interventions are being conducted. When programmes capture the number of people screened (i.e. people given a verbal questionnaire for symptoms, or assessed with a CXR before diagnostic testing) TB prevalence in the population screened can be calculated, and compared to national, regional or catchment area notifications [57]. The monitoring should assess additional TB notifications, comparison of bacteriological positivity rates, and include costing analysis
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