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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

1
Department of Microbiology and Immunology, KU Leuven, Herestraat 49, Box 1030, 3000 Leuven, Belgium.
2
Ambassadeurs de Lutte Contre la Tuberculose, Bukavu, Democratic Republic of Congo.
3
Section of Infectious Diseases and Immunity, Imperial College London, London, England.
4
Coordination Provinciale Lèpre et Tuberculose du Sud-Kivu, Bukavu, Democratic Republic of Congo.
5
Challenge TB, United States Agency for International Development, United States of America.
6
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.
7
International Union against Tuberculosis and Lung Disease, Paris, France.
8
Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.

Abstract

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

Objective:

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.

Methods:

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).

Findings:

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.

Conclusion:

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.

PMID:
30104792
PMCID:
PMC6083386
DOI:
10.2471/BLT.17.203968
[Indexed for MEDLINE]
Free PMC Article

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