Abstract
Community-based active case finding (ACF) is needed to reach key/vulnerable populations with limited access to tuberculosis (TB) care. Published reports of ACF interventions in Indonesia are scarce. We conducted an evaluation of a multicomponent community-based ACF intervention as it scaled from one district to nine in Nias and mainland North Sumatra. Community and health system support measures including laboratory strengthening, political advocacy, sputum transport, and community awareness were instituted. ACF was conducted in three phases: pilot (18 months, 1 district), intervention (12 months, 4 districts) and scale-up (9 months, 9 districts). The pilot phase identified 215 individuals with bacteriologically positive (B+) TB, representing 42% of B+ TB notifications. The intervention phase yielded 509, representing 54% of B+ notifications and the scale-up phase identified 1345 individuals with B+ TB (56% of notifications). We observed large increases in B+ notifications on Nias, but no overall change on the mainland despite district variation. Overall, community health workers screened 377,304 individuals of whom 1547 tested positive, and 95% were initiated on treatment. Our evaluation shows that multicomponent community-based ACF can reduce the number of people missed by TB programs. Community-based organizations are best placed for accessing and engaging hard to reach populations and providing integrated support which can have a large positive effect on TB notifications.
Highlights
Tuberculosis (TB) has existed for millennia yet is the leading infectious disease killer worldwide [1]
Due to the paucity of literature on active case finding (ACF) in Indonesia and the need to improve case detection, we report on the results of an evaluation of an ACF intervention in Nias archipelago and mainland North Sumatra, Indonesia funded by Stop TB partnership’s TB REACH initiative [25]
There were 509 people with B+ TB notified in Nias Selatan during this phase, meaning community outreach efforts were responsible for 42% of the total B+ notifications during the pilot period
Summary
Tuberculosis (TB) has existed for millennia yet is the leading infectious disease killer worldwide [1]. In 2018, a United Nations (UN) High-Level Meeting reaffirmed the global commitment to meeting previously established ambitious targets and strategies to end TB by 2030 and set out interim targets for 2022 on the numbers of people treated for TB [2]. It is estimated that 3 million people with TB are undetected and/or remain unnotified to National TB Programs (NTPs) globally [1]. Lack of accessibility and availability of TB services are major drivers for this [3]. Those who are missed are often members of key/vulnerable populations (i.e., miners, prisoners, elderly, people living with human immunodeficiency virus (HIV), or people in hard to reach areas) [4,5]. To reach more people with TB, active case finding (ACF) strategies focused outside traditional health facilities are needed [8,9,10]
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