Impact Of Active Case Finding Research Articles

A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India

BackgroundTuberculosis (TB) remains a significant public health burden in India, with elimination targets set for 2025. Active case finding (ACF) is crucial for improving TB case detection rates, although conclusive evidence of its association with treatment outcomes is lacking. Our study aims to investigate the impact of ACF on successful TB treatment outcomes among pulmonary TB patients in Gujarat, India, and explore why ACF positively impacts these outcomes.MethodsWe conducted a retrospective cohort analysis in Gujarat, India, including 1,638 pulmonary TB cases identified through ACF and 80,957 cases through passive case finding (PCF) from January 2019 to December 2020. Generalized logistic mixed-model compared treatment outcomes between the ACF and PCF groups. Additionally, in-depth interviews were conducted with 11 TB program functionaries to explore their perceptions of ACF and its impact on TB treatment outcomes.ResultsOur analysis revealed that patients diagnosed through ACF exhibited 1.4 times higher odds of successful treatment outcomes compared to those identified through PCF. Program functionaries emphasized that ACF enhances case detection rates and enables early detection and prompt treatment initiation. This early intervention facilitates faster sputum conversion and helps reduce the infectious period, thereby improving treatment outcomes. Functionaries highlighted that ACF identifies TB cases that might otherwise be missed, ensuring timely and appropriate treatment.ConclusionACF significantly improves TB treatment outcomes in Gujarat, India. The mixed-methods analysis demonstrates a positive association between ACF and successful TB treatment, with early detection and prompt treatment initiation being key factors. Insights from TB program functionaries underscore the importance of ACF in ensuring timely diagnosis and treatment, which are critical for better treatment outcomes. Expanding ACF initiatives, especially among hard-to-reach populations, can further enhance TB control efforts. Future research should focus on optimizing ACF strategies and integrating additional interventions to sustain and improve TB treatment outcomes.

Impact of Active Case Finding on Clinical Structure and Severity of Tuberculosis in School-Aged Children (7-15 Years Old)

The objective: to evaluate the impact of active case finding in children 7-15 years old on the clinical structure of tuberculosis and epidemic risk of detected patients.Subjects and Methods: 1,679 children aged 7-15 ill with tuberculosis.Result. The following has been observed in active case finding of tuberculosis versus tuberculosis detection when the patient is seeking medical care: A 9-fold reduction in the risk of disseminated and generalized tuberculosis; a 4.5-fold reduction in the risk of epidemically dangerous cases of tuberculosis; a 6-fold reduction in the risk of destructive forms of pulmonary tuberculosis. Cases of extrapulmonary tuberculosis were more frequently detected when patients were seeking medical care.Thus, the strategy adopted in Russia for active tuberculosis detection in children leads to significant results: preventing the spread of tuberculous infection in children's communities and reducing the proportion of severe forms of tuberculosis that create the risk of disability and death from tuberculosis.

The impact of active case finding on transmission dynamics of tuberculosis: A modelling study

BackgroundIn the last decade, active case finding (ACF) strategies for tuberculosis (TB) have been implemented in many diverse settings, with some showing large increases in case detection and reporting at the sub-national level. There have also been several studies which seek to provide evidence for the benefits of ACF to individuals and communities in the broader context. However, there remains no quantification of the impact of ACF with regards to reducing the burden of transmission. We sought to address this knowledge gap and quantify the potential impact of active case finding on reducing transmission of TB at the national scale and further, to determine the intensification of intervention efforts required to bring the reproduction number (R0) below 1 for TB.MethodsWe adopt a dynamic transmission model that incorporates heterogeneity in risk to TB to assess the impact of an ACF programme (IMPACT TB) on reducing TB incidence in Vietnam and Nepal. We fit the models to country-level incidence data using a Bayesian Markov Chain Monte Carlo approach. We assess the impact of ACF using a parameter in our model, which we term the treatment success rate. Using programmatic data, we estimate how much this parameter has increased as a result of IMPACT TB in the implementation districts of Vietnam and Nepal and quantify additional efforts needed to eliminate transmission of TB in these countries by 2035.ResultsExtending the IMPACT TB programme to national coverage would lead to moderate decreases in TB incidence and would not be enough to interrupt transmission by 2035. Decreasing transmission sufficiently to bring the reproduction number (R0) below 1, would require a further intensification of current efforts, even at the sub-national level.ConclusionsActive case finding programmes are effective in reducing TB in the short term. However, interruption of transmission in high-burden countries, like Vietnam and Nepal, will require comprehensive incremental efforts. Complementary measures to reduce progression from infection to disease, and reactivation of latent infection, are needed to meet the WHO End TB incidence targets.

Impact of Active Case Finding on Treatment Outcomes in Adult Pulmonary Tuberculosis Patients

The objective:to assess the effect of active finding of tuberculosis cases on the frequency of bacterial excretion, lung tissue destruction, and treatment outcomes.Subjects and Methods.The characteristics of adult patients (newly detected - new cases and those with relapsed pulmonary tuberculosis) were studied in 2 phases: a) 1,404 cases, including 814 actively found, at detection; b) the outcomes of the completed first course of chemotherapy in 946 patients, including 565 actively detected, registered for treatment in 2017 and 2018. Adjusted relative risk (aOR) and statistical significance of differences were calculated.Results.Patients detected actively versus those detected by self presentation to a medical unit had a lower level of positive results of smear microscopy (aOR = 2.7;p< 0.01) and lung tissue destruction (aOR = 1.4;p= 0.01), but the level of positive culture was equal (aOR = 0.9;p= 0.6). Active case finding had no effect on treatment failure rate but if a patient is HIV negative and young, it reduced the risk of death in tuberculosis patients during treatment (aOR = 0.3;p< 0.01). Active case finding, along with no history of previous treatment, negative HIV status, and older age were inversely associated with treatment interruption (aOR = 0.3;p< 0.01).

The impact of active case finding among high-risk populations on the decline of tuberculosis incidence

Introduction: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. In 2019 the WHO reported approximately 10 million TB cases and 1.4 million deaths worldwide. TB still remains one of the leading causes of death in humans. Brazil is one of 30 countries with the highest TB burden with 96,000 new cases and 6,700 deaths reported in 2019. From 2015 the TB incidence is increasing by 2%–3% annually. It means that TB control programs need to be improved. Aim: Our aim is to show the impact of active case finding of TB cases among a high-risk subpopulation on decline of the incidence in the general population. Material and methods: We use a SIS-type compartmental mathematical model to describe the disease dynamics. We consider the population as a heterogeneous population which differ in disease transmission risk. Using best-fit techniques we compare the actual data with the model. For the fitted parameters we calculate the basic reproduction number and estimate the TB trends for the next few years applying several preventative protocols. Results and discussion: Using numerical simulations we examine the impact of ACF on the disease dynamics. We show that active screening among high risk subpopulations can help to reduce TB spread. We show how the reproduction number and estimated incidence decline depend on the detection rate. Conclusions: Active screening is one of the most effective ways for reducing the spread of disease. However, due to financial constraints, it can only be used to a limited extent. Properly applied detection can limit the spread of the disease while minimizing costs.

To study the impact of active case finding (ACF) among the TB patients detected in South Delhi

BackgroundTB is one of the top 10 causes of death worldwide. The WHO adopted the End TB Strategy with ambitious goal of ending the global TB epidemic by 2030. The targets for this were 95% reduction in number of TB deaths, 90% reduction in TB incidence rate between 2015 and 2035 and to ensure that no family is burdened with catastrophic expenditure due to TB. Enhanced case detection is one of the components of End TB strategy adopted by WHO and within this Active Case Finding has an important place. However, its role in the Indian context needs to be assessed. Aims and objectivesTo study the impact of Active Case Finding (ACF) in National Tuberculosis Elimination Program (NTEP) implementing area of National Institute of TB and Respiratory Diseases New Delhi in terms of case detection and treatment outcome. Materials and methodsThe TB patients detected during ACF through house to house survey in vulnerable population were identified, evaluated and followed up. Data from ACF records and TB treatment cards were filled in a pretested proforma and compared with passive case detection in the previous month from same area. ResultsIn December 2017 a total 8600 vulnerable population (living in slums, camps and night shelters) were screened over two weeks of whom 85 were found to have symptoms suggestive of TB of whom 19 were PTB that gives a case detection rate of 220 per lakh population. PTB case detection rate by passive case finding (PCF) in November 2017 from the same area of our study was found to be 63 per lakh population. This difference between the detection rate in ACF and passive case findings was statistically significant with Z proportion test and p value <0.00001. Treatment success rate was 75% and lost to follow up rate was 25% patients among the PTB patients detected in ACF. In passive case detection from the same area in November 2017 treatment success rate was 81.8% and lost to follow up rate (LTFU) was 18% in PTB patients. Even though LTFU rate was slightly higher but was not statistically significant. ConclusionACF is an effective way to find additional cases of TB. ACF is more labour intensive than PCF but if judiciously used under national programme to target specific vulnerable population of society it can produce additional number of TB cases which otherwise would have gone undiagnosed.However, treatment outcome for these patients is below the target and hence to get the maximum impact of ACF there is a need to enhance the adherence to treatment through different methodologies. Poor treatment adherence will lead to increase transmission risk in communities and greater chance of developing drug resistance. Further studies with larger representative population should be undertaken in order to get more conclusive.

Open flanks in the management of tuberculosis in Germany under the pressure of migration.

To prevent transmission is the ultimate goal of any TB control strategy. So far, asylum seekers/immigrants are only actively screened for TB after arrival in Germany, if admitted to mass accommodation facilities. The current TB control strategy in Germany is assessed by a SWOT-analysis (strengths, weaknesses, opportunities and threats) including the impact of active case finding, environmental case finding (ECF) also known as contact tracing, passive case finding (PCF) and effective TB treatment. According to the number-needed-to-screen (NNS), asylum seekers from most countries and unaccompanied minors would have to be screened for active TB by a chest radiograph at entry independently of the type of accommodation. This would include children between 10 and 15years of age and a follow-up for at least 3 to 5years, with a denser follow-up in the first year. ECF and PCF only contribute little to a proactive reduction of the pre-patency period. The available data on the epidemiology and the NNS of TB in migrants are sufficient to come up with a more powerful control strategy for TB in migrants in Germany to close the existing open flanks. It is time for action.

Costs and operation management of community outreach program for tuberculosis in tribal populations in India.

To evaluate costs of an active case finding (ACF) program with tuberculosis (TB) treatment delivery and monitoring, which targeted a rural tribal population in India. A time and motion study was conducted to evaluate operations and workload. Costs from the program perspective were assessed using both the bottom-up and top-down costing methods, exclusive of routine TB care costs. The impact of ACF on routine TB laboratory workloads was measured based on the changes in available staff time per smear at nine designated microscopy centers before and after program implementation. A majority (53.2%) of the community health-care worker's time was spent in traveling to communities, with an average of 22 TB patients (95% CI 19.14-24.94) seen per day per person. Costs (at 2015 $US rates) were US$1.85-US$2.42 per patient screened and submitting sputum, US$2.51-US$4.74 per person diagnosed with TB, and US$22.52-US$34.13 per TB patient completing treatment. Total smear volumes increased significantly after the ACF program, with more than a 15% reduction in available staff time per sputum smear test in most laboratories. This low-cost, ACF program has the potential to be highly cost-effective in addressing gaps in TB care problems in rural India.

Effect of active case finding on dengue control: Implications from a mathematical model

Dengue control in India is a challenging task due to complex healthcare settings. In yesteryears, an amplification of dengue infections in India posed the need for introspection of existing dengue control policies. Prior understanding of the impacts of control interventions is necessary for their future implementation. In this paper, we propose and analyze a compartmental model of dengue to assess the impact of active case finding (ACF) on dengue disease transmission. Currently, primary prevention of dengue is possible only with vector control and personal protection from the bites of infected mosquitoes. Although a few experimental studies are performed to assess ACF in dengue disease, but this is the first attempt to represent and study the dynamics of disease using ACF as a control strategy. Local and global dynamics of the system are studied. We use sensitivity analysis to see the effects of controllable parameters of the model on the basic reproduction number and total number of infective population. We find that decrease in the biting rate of mosquitoes, and increase in the rate of hospitalization and/or notification, death rate of mosquitoes and ACF for asymptomatic and symptomatic individuals play crucial role for the reduction of disease prevalence. We calibrate our model to the yearly dengue cases in eight dengue endemic states of India. The results of our study show that ACF of symptomatic individuals will have significant effect on dengue case reduction but ACF of asymptomatic individuals cannot be ignored. Our findings indicate that the healthcare organizations must focus on ACF of symptomatic as well as asymptomatic individuals along with personal protection and mosquitoes control to achieve rapid reduction of dengue cases in India.

An intervention of active TB case finding among smokers attending routine primary care facilities in China: an exploratory study.

Smoking is an important risk factor of TB. However, no studies have been conducted to identify TB cases from smokers. We assessed the process and initial impact of active case finding among smokers at primary care facilities in a setting with high smoking rates and TB burden. A prospective quasi-experimental study was conducted in para-urban communities in Yunnan China between September 2013 and June 2014. Smokers attending primary care facilities in the intervention group were prescribed chest X-rays if they had diabetes or TB symptoms, or were elders or close contacts of TB patients. Those with X-rays suggestive of TB were referred to TB dispensaries for diagnosis. Passive case finding was practiced in the control group. In the intervention group, we screened 471 smokers with high risks of TB, of whom 73% took chest X-ray examinations. Eight TB cases were diagnosed, reflecting a 1.7% yield rate of all screened smokers. Smokers with diabetes (OR 6.003, 95% CI 1.057-34.075) were more likely to have TB compared with those without. In total, the intervention group reported significantly higher TB notification rate compared with the control group (38.6 vs 22.9 per 100 000, p=0.016). Active case finding among smokers with high risks of TB was feasible and contributed to improved notification rates.