One size does not fit all: reaching agricultural workers in South Africa with TB services

BACKGROUND: Despite decreasing incidence of TB in South Africa, people with TB continue to be missed by facility-based case-finding interventions, and agricultural workers suffer disproportionately from limited access to services. We implemented two community-based active case-finding strategies to engage agricultural workers and assessed the cost of these interventions.METHODS: We summarized costs for two interventions - one led by enrolled nurses and one by non-governmental organizations (NGOs) - from April 2017 to December 2019, and calculated cost per person reached by services, screened for TB, identified as having TB and started on TB treatment. We performed Mann-Kendall tests of monotonic trend and conducted a sensitivity analysis of intervention costs.RESULTS: The enrolled nurses-led implementation started 442 people on TB treatment at a cost of US$118 per person, with decreasing trend in costs over the implementation period (P = 0.005). The NGO-led intervention started 160 people on treatment at a cost of US$554 per person, with decreasing trend in costs over the implementation period (P = 0.004).CONCLUSION: Community-based case-finding strategies find TB patients who would be missed by the health system. These strategies should be scaled up to close the missing cases gap in South Africa and to meet UN targets for ending TB.