Active versus passive case finding for tuberculosis in marginalised and vulnerable populations in India: comparison of treatment outcomes

Glob Health Action. 2019;12(1):1656451. doi: 10.1080/16549716.2019.1656451.

Abstract

Background: Community-based active case finding (ACF) for tuberculosis (TB) implemented among marginalised and vulnerable populations in 285 districts of India resulted in reduction of diagnosis delay and prevalence of catastrophic costs due to TB diagnosis. We were interested to know whether this translated into improved treatment outcomes. Globally, there is limited published literature from marginalised and vulnerable populations on the independent effect of community-based ACF on treatment outcomes when compared to passive case finding (PCF). Objectives: To determine the relative differences in unfavourable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) of ACF and PCF-diagnosed people. Methods: Cohort study involving record reviews and interviews in 18 randomly selected districts. We enrolled all ACF-diagnosed people with new smear-positive pulmonary TB, registered under the national TB programme between March 2016 and February 2017, and an equal number of randomly selected PCF-diagnosed people in the same settings. We used log binomial models to adjust for confounders. Results: Of 572 enrolled, 275 belonged to the ACF and 297 to the PCF group. The proportion of unfavourable outcomes were 10.2% (95% CI: 7.1%, 14.3%) in the ACF and 12.5% (95% CI: 9.2%, 16.7%) in the PCF group (p = 0.468). The association between ACF and unfavourable outcomes remained non-significant after adjusting for confounders available from records [aRR: 0.83 (95% CI: 0.56, 1.21)]. Due to patient non-availability at their residence, interviews were conducted for 465 (81.3%). In the 465 cohort too, there was no association after adjusting for confounders from records and interviews [aRR: 1.05 (95% CI: 0.62, 1.77)]. Conclusion: We did not find significant differences in the treatment outcomes. Due to the wide CIs, studies with larger sample sizes are urgently required. Studies are required to understand how to translate the benefits of ACF to improved treatment outcomes.

Keywords: Tuberculosis/therapy; community-based active case finding; systematic screening; treatment outcome; vulnerable populations.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Humans
  • India / epidemiology
  • Interviews as Topic
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Prevalence
  • Qualitative Research
  • Treatment Outcome
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy*
  • Tuberculosis, Pulmonary / epidemiology*
  • Vulnerable Populations*
  • Young Adult

Grants and funding

The author(s) received no specific funding for this study. The study was conducted in operational settings and we used existing resources to implement this study. The open access publications costs were funded by the Department for International Development (DFID), UK and La Fondation Veuve Emile Metz-Tesch (Luxembourg).The authors would like to acknowledge funding support for Project Axshya from The Global Fund TB grant to India. The Project is implemented by the Project Management Unit of The Union South-East Asia (USEA) since 2010 till date with support of the sub-recipient partners (in alphabetical order): The Catholic Bishops’ Conference of India-Coalition for AIDS and Related Diseases (CBCI-CARD); The Catholic Health Association of India (CHAI); Emmanuel Hospital Association (EHA); MAMTA Health Institute for Mother and Child; Population Services International (PSI); Resource Group for Education and Advocacy for Community Health (REACH); and Voluntary Health Association of India (VHAI).