Implementation and Operational Research: Population-Based Active Tuberculosis Case Finding During Large-Scale Mobile...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health

Background:

• Undiagnosed active tuberculosis (TB) remains a significant public health challenge, particularly in resource-limited settings.
• Community-based screening initiatives are crucial for reducing the burden of undiagnosed TB.
• Integrating TB screening into existing health campaigns can enhance case detection rates.

Purpose of the Study:

• To evaluate the effectiveness of TB screening integrated into community-based HIV testing campaigns (CHC) in rural Uganda.
• To determine the yield of TB screening, including the number needed to screen (NNS) for new TB cases.
• To assess the linkage to care and treatment completion for newly diagnosed TB patients.

Main Methods:

• A cluster-randomized trial (SEARCH, NCT:01864603) in 7 rural Ugandan communities.
• Offered sputum microscopy for TB screening to participants reporting prolonged cough (>2 weeks) during CHCs.
• Collected data on TB case yield, NNS, and linkage to TB care.

Main Results:

• Out of 27,214 participants in CHCs, 2876 (11%) had prolonged cough, leading to 1099 sputum samples collected.
• Ten adults had AFB-positive sputum, with 9 new TB diagnoses.
• The NNS to identify one new TB case was 3024 overall, significantly lower among those with prolonged cough (320) and HIV-infected individuals with prolonged cough (80).
• All 9 newly diagnosed individuals were linked to TB care and initiated treatment within 2 weeks.

Conclusions:

• TB screening integrated with large-scale mobile HIV testing campaigns is an effective strategy for increasing TB case detection in rural Uganda.
• This integrated approach facilitates early diagnosis and linkage to care for TB patients.
• Community-based screening offers a valuable opportunity to address undiagnosed TB in high-burden settings.