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Lessons learned from community-based tuberculosis case-finding in western Kenya.

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Community health workers paid daily wages significantly increased attendance at mobile tuberculosis (TB) and HIV screening units in Kenya. This strategy enhances the efficiency of mobile health services for infectious disease diagnosis.

Keywords:
community health workershuman immunodeficiency virusmobile health units

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Health Services Research

Background:

  • Kenya faces a high burden of tuberculosis (TB), with only 46% of cases diagnosed in 2016.
  • Community-based mobile screening units are crucial for reaching populations with limited access to healthcare.

Purpose of the Study:

  • To identify strategies for increasing attendance at community-based mobile screening units.
  • To optimize the effectiveness and efficiency of mobile health services for TB and HIV screening.

Main Methods:

  • Analysis of operational data from a cluster-randomised trial of mobile screening units (February 2015-April 2016).
  • Community health volunteers (CHVs) recruited symptomatic individuals for HIV testing and Xpert MTB/RIF testing.
  • Comparison of attendance rates across different mobile unit sites using Wilcoxon rank-sum test.

Main Results:

  • 1424 adults with symptoms were screened across 25 mobile unit sites.
  • Median TB diagnosis yield was 2.4%; median new HIV diagnosis yield was 2.5%.
  • Significantly higher attendance was observed at rural sites where CHVs were paid a daily minimum wage compared to a monthly stipend (P < 0.001).

Conclusions:

  • Mobile screening units are most effective and efficient when implemented as a single event.
  • Daily wage payment for community health workers is a key strategy for increasing attendance at mobile health screening units.
  • Optimizing CHV compensation models can improve the reach and impact of infectious disease screening programs.