An evaluation of passive and active approaches to improve TB notifications in Afghanistan
Abstract
Background
In Afghanistan, improving
TB case detection remains challenging. In 2014, only half of the
estimated incident TB cases were notified, and notifications
have decreased since peaking in 2007. Active case finding has
been increasingly considered to improve TB case notifications.
While access to health services has improved in Afghanistan, it
remains poor and many people seeking health services won’t
receive proper care.
Methods
From October 2011 through
December 2012 we conducted three separate case finding
strategies in six provinces of Afghanistan and measured impact
on TB case notification. Systematically screening cough among
attendees at 47 health facilities, active household contact
investigation of smear-positive index TB patients, and active
screening at 15 camps for internally displaced people were
conducted. We collected both intervention yield and official
quarterly notification data. Additional TB notifications were
calculated by comparing numbers of cases notified during the
intervention with those notified before the intervention, then
adjusting for secular trends in notification.
Results
We screened 2,022,127 people
for TB symptoms during the intervention, tested 59,838 with
smear microscopy and detected 5,046 people with smear-positive
TB. Most cases (81.7%, 4,125) were identified in health
facilities while nearly 20% were found through active case
finding. A 56% increase in smear-positive TB notifications was
observed between the baseline and intervention periods among the
47 health facilities, where cases detected by all three
strategies were notified.
Discussion
While most people with TB
are likely to be identified through health facility screening,
there are many people who remain without a proper diagnosis if
outreach is not attempted. This is especially true in places
like Afghanistan where access to general services is poor.
Targeted active case finding can improve the number of people
who are detected and treated for TB and can push towards the
targets of the Stop TB Global Plan and End TB Strategy.
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Source:
PLOS ONE
