Development and Evaluation of Active Case Detection Methods to Support Visceral Leishmaniasis Elimination in India

Frontiers in Cellular and Infection Microbiology

Parna Chakraborty¹  Ankur Kumar¹  Nasreen Bano¹  Morchan Karthick¹  Shweta Dwivedi¹  Niraj Kumar¹  Sridhar Srikantiah¹  Aritra Das¹  Chandan Prasad¹  Joy Bindroo¹  Aditya Kumar¹  Kumar Kundan¹  Tanmay Mahapatra¹  Hemant Shah¹  Indrajit Chaudhuri¹  Pushkar Dubey¹  Prabhas Kumar Mishra¹  Chandan Kumar¹  Abhishek Kumar Singh¹  Bikas Sinha¹  Sreya Pradhan¹  Basab Rooj¹  Indranath Banerjee¹  Khushbu Priyamvada¹  Manash Kumar¹  Sunil Babu¹  Rakesh Kumar¹  Chandramani Singh²  Madan Prasad Sharma³  Lloyd A C. Chapman⁴  Allen W. Hightower⁵  Ana O. Franco⁶  Caryn Bern⁶  Naresh Kumar Gill⁷  Neeraj Dhingra⁷  Nupur Roy⁷ 

[1] Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India;Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India;Department of Health, Government of Bihar, Patna, India;Department of Medicine, University of California, San Francisco, San Francisco, CA, United States;Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom;Independent Consultant, Bangkok, Thailand;Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States;National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, Government of India, Delhi, India;

关键词: active case detection;    visceral leishmaniasis;    visceral leishmaniasis elimination;    evaluation of active case detection;    India;    surveillance;   

DOI  :  10.3389/fcimb.2021.648903

来源: Frontiers

【 摘 要 】

As India moves toward the elimination of visceral leishmaniasis (VL) as a public health problem, comprehensive timely case detection has become increasingly important, in order to reduce the period of infectivity and control outbreaks. During the 2000s, localized research studies suggested that a large percentage of VL cases were never reported in government data. However, assessments conducted from 2013 to 2015 indicated that 85% or more of confirmed cases were eventually captured and reported in surveillance data, albeit with significant delays before diagnosis. Based on methods developed during these assessments, the CARE India team evolved new strategies for active case detection (ACD), applicable at large scale while being sufficiently effective in reducing time to diagnosis. Active case searches are triggered by the report of a confirmed VL case, and comprise two major search mechanisms: 1) case identification based on the index case’s knowledge of other known VL cases and searches in nearby houses (snowballing); and 2) sustained contact over time with a range of private providers, both formal and informal. Simultaneously, house-to-house searches were conducted in 142 villages of 47 blocks during this period. We analyzed data from 5030 VL patients reported in Bihar from January 2018 through July 2019. Of these 3033 were detected passively and 1997 via ACD (15 (0.8%) via house-to-house and 1982 (99.2%) by light touch ACD methods). We constructed multinomial logistic regression models comparing time intervals to diagnosis (30-59, 60-89 and ≥90 days with <30 days as the referent). ACD and younger age were associated with shorter time to diagnosis, while male sex and HIV infection were associated with longer illness durations. The advantage of ACD over PCD was more marked for longer illness durations: the adjusted odds ratios for having illness durations of 30-59, 60-89 and >=90 days compared to the referent of <30 days for ACD vs PCD were 0.88, 0.56 and 0.42 respectively. These ACD strategies not only reduce time to diagnosis, and thus risk of transmission, but also ensure that there is a double check on the proportion of cases actually getting captured. Such a process can supplement passive case detection efforts that must go on, possibly perpetually, even after elimination as a public health problem is achieved.

【 授权许可】

CC BY