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Precision geospatial targeting for cost-effective tuberculosis case finding in Eastern Uganda: a quasi-experimental
Clark Joshua Brianwong1, Diana Cherotin2, Lwanga Sssekiswa Zimwanguyiza2
1Medical and psychosocial, Baylor College of Medicine Children's Foundation Uganda, Kampala 72052, Uganda.
Therapeutic Advances in Infectious Disease
|June 15, 2026
Summary
Geospatial targeting using electronic surveillance data significantly improved tuberculosis screening efficiency and cost-effectiveness in Uganda. This data-driven approach reduced screening volume by 92.1% while increasing case yield and lowering costs.
Area of Science:
- Public Health
- Epidemiology
- Geospatial Analysis
Background:
- Universal community-based tuberculosis (TB) screening is resource-intensive and inefficient in high-burden settings.
- Integrating routine surveillance data with geospatial analytics can enhance active TB case finding efficiency and cost-effectiveness.
Purpose of the Study:
- To evaluate if integrating Uganda's electronic Case-Based Surveillance System (eCBSS) data with geospatial hotspot analytics improves TB case finding (CAST+) efficiency, yield, and cost-effectiveness in Eastern Uganda.
Main Methods:
- A quasi-experimental before-and-after study compared universal vs. targeted TB screening campaigns.
- Geospatial hotspot analysis using eCBSS data identified high-risk areas for targeted screening.
- Cost-effectiveness was evaluated using disability-adjusted life years (DALYs) averted and cost-effectiveness ratios (CERs).
Main Results:
- The targeted strategy screened 92.1% fewer individuals but increased TB yield by 10% (1.68% to 1.85%).
- Total costs decreased by 90.9% (USD 62,804 to USD 5704), and cost per TB case fell by 55.2% (USD 82.20 to USD 36.80).
- Cost per DALY averted decreased from USD 4.72 to USD 2.11, with an ICER of USD 5.39.
Conclusions:
- eCBSS-guided geospatial targeting enhances TB screening efficiency, precision, and cost-effectiveness.
- This supports a shift from universal to targeted TB case finding strategies.
- Provides evidence for high-value public health interventions in resource-limited settings.
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