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Bull World Health Organ. 2018 Aug 1;96(8):522-530. doi: 10.2471/BLT.17.203968. Epub 2018 Jun 4.

Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo.

Author information

Department of Microbiology and Immunology, KU Leuven, Herestraat 49, Box 1030, 3000 Leuven, Belgium.
Ambassadeurs de Lutte Contre la Tuberculose, Bukavu, Democratic Republic of Congo.
Section of Infectious Diseases and Immunity, Imperial College London, London, England.
Coordination Provinciale Lèpre et Tuberculose du Sud-Kivu, Bukavu, Democratic Republic of Congo.
Challenge TB, United States Agency for International Development, United States of America.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.
International Union against Tuberculosis and Lung Disease, Paris, France.
Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.


in English, Arabic, Chinese, French, Russian, Spanish


To investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic of the Congo, especially among groups at high risk of tuberculosis infection.


To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselves received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the intervention (2014-2016).


Acceptability of the intervention was high. Volunteers screened 650 434 individuals in their communities, 73 418 of whom reported a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened, costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with poorer access to health care represented only 5.1% (33 002/650 434) of those screened, they contributed 19.7% (845/4300) of tuberculosis diagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% (4 300/10 247) of the provincial total for that period.


Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used to assist health systems in the elimination of tuberculosis.

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