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Impact of integrating tuberculosis and orphans and vulnerable children services on case-finding and treatment
Adeodata R Kekitiinwa1, Michael Juma1, Cathbert Tumusiime1
1Baylor College of Medicine Children's Foundation.
Insights
Integrating tuberculosis (TB) services into programs for orphans and vulnerable children (OVC) significantly boosted TB screening and diagnosis rates. This approach effectively reached vulnerable populations, improving TB case-finding and care access.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Global Health
Background:
- Orphans and vulnerable children (OVC) face heightened risks of tuberculosis (TB) due to factors like poverty, malnutrition, overcrowding, and HIV.
- Integrating TB and OVC services in Uganda aimed to improve health outcomes for this high-risk group.
Purpose of the Study:
- To evaluate the impact of integrating TB and OVC services on TB screening, diagnosis, and treatment outcomes in Uganda.
- To assess the effectiveness of community-based approaches in reaching OVC beneficiaries with TB services.
Main Methods:
- A comparative study design was used, analyzing TB screening, diagnostic, and treatment data from October 2021-September 2022 (before integration) and October 2022-September 2023 (after integration).
- Community-based staff conducted in-home TB screening, specimen collection, facility accompaniment, and adherence counseling for OVC beneficiaries.
- Chi-square and Fisher's exact tests were employed to compare outcomes between the two periods.
Main Results:
- TB screening increased significantly post-integration, with household members being three times more likely to be screened (RR: 3.13).
- TB diagnosis rates rose tenfold (RR: 10.00), with 100% of positive screens receiving evaluation compared to 9% pre-integration.
- While diagnostic yield decreased (25% post-integration vs. 100% pre-integration), overall case-finding and treatment completion (100%) improved.
Conclusions:
- Integrating TB services into OVC programming substantially enhanced TB screening, diagnostic evaluation, and case-finding among beneficiaries.
- This integrated model effectively addresses gaps in TB care for vulnerable populations who may face barriers to accessing facility-based services.
- Leveraging OVC program infrastructure is a viable strategy for improving TB control in high-risk communities.
Background:
Household poverty, malnutrition, overcrowding, and HIV infection place orphans and vulnerable children (OVC) at increased risk of tuberculosis (TB) disease and other adverse health outcomes. We integrated TB and OVC services in Uganda, comparing TB screening, diagnostic, and treatment outcomes before (October 2021-September 2022) and after (October 2022-September 2023) integration.
Methods:
At baseline, TB services included passive TB screening for OVC program beneficiaries with HIV. During implementation, community-based staff conducted in-home TB screening and specimen collection, accompanied beneficiaries to health facilities, followed up diagnostic results, and provided adherence counselling. We compare screening, diagnosis, and treatment for TB before and after program integration using chi-square and Fisher's exact tests to assess strength of associations.
Results:
Following integration, household members were three times more likely to be screened for TB [RR: 3.13, 95% CI: 3.06-3.2, P < 0.0001] and 10 times more likely to be diagnosed with TB (RR: 10.00, 95% CI: 3.61-27.68, P < 0.0001). Among 46 beneficiaries screening positive prior to integration, only four (9%) received TB diagnostic evaluation compared with 198/198 (100%) following integration ( P < 0.0001). At baseline, all beneficiaries evaluated (4/4, 100%) were diagnosed with TB, compared to 25% (49/198) following integration. All beneficiaries initiating treatment completed it during both time periods.
Conclusion:
Integrating TB services into OVC programming increased TB screening, diagnostic investigation, and case-finding among beneficiaries. These gains highlight the impact of harnessing OVC resources to address gaps in TB care, especially among populations that may face barriers to seeking care at a health facility.
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