Optimizing Active Tuberculosis Case Finding: Evaluating the Impact of Community Referral for Chest X-ray Screening and Xpert Testing on Case Notifications in Two Cities in Viet Nam

Tropical Medicine and Infectious Disease

TuanHo Thanh Luu¹  ThuyThu Thi Dong²  RachelJeanette Forse²  AndrewJames Codlin²  LuanNguyen Quang Vo²  ThuyDoan To Mai²  LanPhuong Nguyen²  TuanHuy Mac³  ThoDuc Nguyen³  PhapNgoc Tran⁴  XanhThu Pham⁵  QuanDuc Nguyen⁵  ThucHuy Phan⁵  VanVan Nguyen⁶  Jacob Creswell⁷  Amera Khan⁷  HoiVan Le⁸  HoaBinh Nguyen⁸  NhungViet Nguyen⁸ 

[1] Clinton Health Access Initiative, Ha Noi 100000, Vietnam;Friends for International TB Relief, Ha Noi 100000, Vietnam;Hai Phong Lung Hospital, Hai Phong 180000, Vietnam;Pham Ngoc Thach Quang Nam Hospital, Quang Nam 560000, Vietnam;Provincial Department of Health, Hai Phong 180000, Vietnam;Provincial Department of Health, Quang Nam 560000, Vietnam;Stop TB Partnership, 1218 Geneva, Switzerland;Viet Nam National Lung Hospital, Ha Noi 100000, Vietnam;

关键词: tuberculosis;    active case finding;    community health workers;    mobile X-ray screening;   

DOI  :  10.3390/tropicalmed5040181

来源: DOAJ

【 摘 要 】

To accelerate the reduction in tuberculosis (TB) incidence, it is necessary to optimize the use of innovative tools and approaches available within a local context. This study evaluated the use of an existing network of community health workers (CHW) for active case finding, in combination with mobile chest X-ray (CXR) screening events and the expansion of Xpert MTB/RIF testing eligibility, in order to reach people with TB who had been missed by the current system. A controlled intervention study was conducted from January 2018 to March 2019 in five intervention and four control districts of two low to medium TB burden cities in Viet Nam. CHWs screened and referred eligible persons for CXR to TB care facilities or mobile screening events in the community. The initial diagnostic test was Xpert MTB/RIF for persons with parenchymal abnormalities suggestive of TB on CXR or otherwise on smear microscopy. We analyzed the TB care cascade by calculating the yield and number needed to screen (NNS), estimated the impact on TB notifications and conducted a pre-/postintervention comparison of TB notification rates using controlled, interrupted time series (ITS) analyses. We screened 30,336 individuals in both cities to detect and treat 243 individuals with TB, 88.9% of whom completed treatment successfully. All forms of TB notifications rose by +18.3% (95% CI: +15.8%, +20.8%). The ITS detected a significant postintervention step-increase in the intervention area for all-form TB notification rates (IRR(β6) = 1.221 (95% CI: 1.011, 1.475); p = 0.038). The combined use of CHWs for active case findings and mobile CXR screening expanded the access to and uptake of Xpert MTB/RIF testing and resulted in a significant increase in TB notifications. This model could serve as a blueprint for expansion throughout Vietnam. Moreover, the results demonstrate the need to optimize the use of the best available tools and approaches in order to end TB.

【 授权许可】

Unknown