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Int J Tuberc Lung Dis. 2019 Jul 1;23(7):844-849. doi: 10.5588/ijtld.18.0700.

Optimizing the efficiency of tuberculosis active case-finding in health facilities and communities.

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Harvard Medical School, Boston, MA, USA.
Kenya Medical Research Institute, Kisumu.
Kenya Medical Research Institute, US Army Medical Research Directorate-Kenya, Kisumu.
US Army Medical Research Directorate-Kenya, Kisumu, Kenya.
Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
CDC-Kenya, Kisumu, Kenya.


SETTING: Efficient tuberculosis (TB) active case-finding strategies are important in settings with high TB burdens and limited resources, such as those in western Kenya.OBJECTIVE: To guide efforts to optimize screening efficiency, we identified the predictors of TB among people screened in health facilities and communities.DESIGN: During February 2015-June 2016, adults aged ≥15 years reporting any TB symptom were identified in health facilities and community mobile screening units, and evaluated for TB. We assessed the predictors of TB using a modified Poisson regression with generalized estimating equations to account for clustering according to screening site.RESULTS: TB was diagnosed in 484 (20.3%) of 2394 symptomatic adults in health facilities and 39 (3.4%) of 1424 in communities. In health facilities, >10% of symptomatic adults in all demographic groups had TB, and no predictors were associated with a ≥2-fold increased risk. In communities, the independent predictors of TB were male sex (adjusted prevalence ratio [aPR] = 4.26, 95%CI 2.43-7.45), HIV infection (aPR 2.37, 95%CI 1.18-4.77), and household TB contact in the last 2 years (aPR 2.84, 95%CI 1.62-4.96).CONCLUSION: Our findings support the notion of general TB screening in health facilities and evaluation of the adult household contacts of TB patients.


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