Tuberculosis active case finding: uptake and diagnostic yield among minibus drivers in urban South Africa.

Tonderai Mabuto,Salome Charalambous,Violet Chihota,Gillian Gresak,Gavin J Churchyard,Christopher J Hoffmann,Ephraim Zwane

doi:10.1186/s12889-015-1592-x

Abstract

BackgroundTuberculosis (TB) active case finding is a part of TB control in areas of higher TB prevalence. Congested public transportation settings may be areas of increased TB transmission. We evaluated the uptake and diagnostic yield of an active TB screening program among minibus drivers in a large public transportation facility in Johannesburg, South Africa.MethodsOver an eight month period, we intensively recruited minibus drivers for TB screening with a goal of 80% uptake among the estimated 2000 drivers. All participants were screened for TB symptoms, offered HIV testing, and had sputum collected for smear microscopy and liquid culture.Results686 drivers were screened for TB, representing an uptake of only 34% of all drivers (43% of the target screening). Ten drivers (1.5%) were culture positive for TB, nine of whom were sputum smear microscopy negative. Factors associated with previously undiagnosed TB included a history of incarceration (odds ratio [OR] 5.5, 95% confidence interval: 1.1, 27.3) and HIV positivity (OR 5.3, 95% confidence interval: 1.1, 26.3).ConclusionsWe identified undiagnosed pulmonary TB cases among drivers but at a level that may be insufficient to justify systematic case finding in this population considering the poor uptake.

Highlights

Tuberculosis (TB) active case finding is a part of TB control in areas of higher TB prevalence
As part of service delivery within a transport center in central Johannesburg, South Africa, we provided walk-in HIV counselling and testing (HCT) coupled with TB screening to commuters and transport workers
The formative interviews identified three key issues: (1) TB screening should be decoupled from HIV testing because drivers unwilling to undergo HCT were interested in TB screening, (2) TB screening needed to be brought to the driver, and (3) the total time required for the process needed to be short (

Summary

Introduction

Tuberculosis (TB) active case finding is a part of TB control in areas of higher TB prevalence. Prevalence and mortality rates are not declining sufficiently to achieve global targets set by the World Health Organisation (WHO) for 2015 [1] This has been partly attributed to the challenge of early identification of infectious cases [2], especially in places or populations with poor access to health care, high levels of undetected TB, or a high risk of transmission [3,4]. They may include specific congregate communities or occupational risk environments that result in increased contact rates, exposure to highly infectious TB, or increased susceptibility to TB disease [5] Identification of these settings, coupled with systematic targeted active case finding (ACF) and treatment efforts may lead to improved TB control [5]

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