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BMC Public Health

, 12:674

First Online: 20 August 2012Received: 27 February 2012Accepted: 10 August 2012DOI: 10.1186-1471-2458-12-674

Cite this article as: Hermans, S., Nasuuna, E., van Leth, F. et al. BMC Public Health 2012 12: 674. doi:10.1186-1471-2458-12-674

Abstract

BackgroundIncreased detection of tuberculosis TB using intensified or active case finding ICF is one of the cornerstones of the Stop TB Strategy, and contrasts with passive case finding PCF which relies on self-reported symptoms. There is no clear guidance on implementation strategies. We implemented ICF in addition to ongoing PCF in our large urban HIV clinic in July 2010 using a twice-daily announcement screen method by a trained peer educator, asking waiting patients to self-refer to a trained peer supporter for screening of TB symptoms. We sought to determine the associated effect on TB case detection.

MethodsSuspects were investigated by sputum smear, chest X-ray and ultrasound, if indicated. Routinely collected clinical and laboratory data were merged with the ICF register and TB clinic data for patients attending the clinic in 2010. We compared the yield of TB cases defined as the prevalence of newly diagnosed TB cases in the screened population, the type of TB diagnosed and the total cost per TB case identified in United States Dollars USD for the period before and after ICF implementation.

ResultsOf the 20,456 patients who visited the clinic in 2010, 614 were identified as TB suspects, 220 pre-ICF and 394 post-ICF 229 via PCF and 165 via ICF. The proportion diagnosed with TB dropped from 66% to 48% 60% in suspects identified through PCF and 31% through ICF. During the post-ICF period, TB suspects identified through ICF compared to PCF identification were more likely to be female, older, on ART and to have been enrolled in HIV care for a longer duration. The yield of combined PCF and ICF screening was 1.4% pre-ICF and 1.7% post-ICF with a cost per TB case identified of 12.29 USD and 21.80 USD, respectively.

ConclusionsImplementation of ICF in a large HIV clinic yielded more TB suspects and cases, but substantially increased costs and was unable to capture the majority of TB suspects who were referred for diagnosis by clinicians through PCF. The overall yield of TB cases in a mature HIV clinic was low, although targeted screening of those recently enrolled in care may increase the yield.

KeywordsIntensified case finding Tuberculosis Screening HIV-AIDS Implementation research Resource-limited setting Costing analysis Yield Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-12-674 contains supplementary material, which is available to authorized users.

Sabine Hermans, Esther Nasuuna contributed equally to this work.

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