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Individuals' Vulnerability Based Active Surveillance for TB: Experiences from India.
Shibu K Balakrishnan1, Rakesh P Suseela1, Sunilkumar Mrithyunjayan2
1World Health Organization Technical Support Network (NTEP), Thiruvananthapuram 695001, India.
Tropical Medicine and Infectious Disease
|December 22, 2022
Summary
Targeting individuals based on vulnerability significantly improved tuberculosis case finding efficiency. This approach reduced the number needed to screen and test, optimizing resource use in low-burden settings.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Community-based active tuberculosis case finding (ACF) is crucial for TB elimination.
- Inefficient ACF in low-burden settings can waste resources and strain health systems.
- Kerala, India, has seen a significant decline in TB incidence, necessitating optimized ACF strategies.
Purpose of the Study:
- To introduce and evaluate an 'individuals'-vulnerability-based active surveillance strategy for tuberculosis.
- To compare the efficiency of vulnerability-based ACF with traditional population-based ACF.
- To enhance health system efficiency in TB case finding.
Main Methods:
- Developed an 'individuals'-vulnerability-based active surveillance approach for tuberculosis.
- Assigned weighted scores reflecting individual TB vulnerability risks.
- Targeted individuals with higher cumulative vulnerability scores for serial ACF.
- Compared case-finding yield metrics (number needed to screen/test) between 2018 (population-based) and 2019 (vulnerability-based).
Main Results:
- The number needed to screen per confirmed pulmonary TB case decreased from 3772 (population-based) to 881 (vulnerability-based).
- The number needed to test per confirmed pulmonary TB case decreased from 112 (population-based) to 39 (vulnerability-based).
- Vulnerability-based ACF demonstrated substantially higher efficiency in diagnosing TB cases.
Conclusions:
- Individuals'-vulnerability-based active surveillance is a practical and efficient alternative to blanket ACF.
- This targeted approach improves health system efficiency by optimizing resource allocation.
- Recommended for settings with stationary populations, low TB burden, and strong health systems.
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