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Yield and Coverage of Active Case Finding Interventions for Tuberculosis Control:A Systematic Review and
Ruth W Deya1, Linnet N Masese2, Walter Jaoko3
1University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya.
Tuberculosis Research and Treatment
|July 15, 2022
Summary
Active case finding (ACF) for tuberculosis (TB) is effective, with high screening coverage. Laboratory-based screening, especially in high-prevalence settings like displaced person camps, significantly increases tuberculosis case detection rates.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Global Health
Background:
- Active case finding (ACF) is crucial for tuberculosis (TB) control, aiming to reduce diagnosis delays, expedite treatment, and prevent transmission.
- Optimizing ACF strategies is essential to maximize screening coverage and case detection yield.
Purpose of the Study:
- To identify optimal populations, settings, and screening/diagnostic approaches for tuberculosis ACF programs.
- To evaluate factors influencing coverage and yield in tuberculosis ACF.
Main Methods:
- A comprehensive literature search identified 224 studies on tuberculosis ACF from 1980-2016.
- Meta-analyses and meta-regression were used to estimate pooled coverage and yield, and to identify predictors of these outcomes.
Main Results:
- Pooled coverage for tuberculosis ACF was high at 93.5%, with a pooled yield of 3.2%.
- Highest yields were observed in internally-displaced persons camps (15.6%) and healthcare facilities (6.9%).
- Screening individuals regardless of symptoms using laboratory tests (microscopy, culture, Xpert) increased yield by 3.7% compared to symptom screening. Targeting persons living with HIV (PLWH) and children resulted in significantly higher yields.
Conclusions:
- Tuberculosis ACF is implementable across diverse populations and settings.
- Laboratory-based screening, irrespective of symptoms, and targeted approaches for PLWH and children enhance tuberculosis detection.
- High-yield settings include displaced person camps and healthcare facilities, particularly in high-prevalence areas.
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