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Open Access Community-based active case finding for tuberculosis in rural western China: a cross-sectional study

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SETTING: Current passive case finding strategies are not effective at identifying tuberculosis (TB) patients in rural China.

OBJECTIVE: To evaluate a community-based, active case finding (ACF) scheme in identifying symptomatic individuals with TB.

DESIGN: We conducted door-to-door household visits of all residents aged 15 years at two rural sites to screen for TB symptoms. Individuals with symptoms were enrolled and asked to provide three sputum samples. All participants underwent chest X-ray, and microbiologic detection of Mycobacterium tuberculosis from sputum samples using microscopy, solid culture and Xpert® MTB/RIF was performed.

RESULTS: Among the 19 334 residents screened for TB symptoms, 865 (4.5%) reported having 1 symptom. A total of 52 TB cases were detected, 11 of whom had microbiologic confirmation. Xpert identified all five M. tuberculosis culture-positive cases and yielded an additional three diagnoses. Prevalence of newly detected TB at the two sites through ACF was respectively 475 and 196 per 100 000 population. These estimates are respectively four and eight times, on average, higher than those identified through passive surveillance during the previous 5-year period for the two sites.

CONCLUSION: Community-based symptom screening followed by laboratory tests was found to be feasible and effective in increasing TB case finding in rural China.
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Keywords: Xpert; epidemiology; population-based study; rural settings

Document Type: Research Article

Affiliations: 1: Aeras, Beijing, China, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany 2: Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science, Fudan University, Shanghai, China, Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA 3: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany, Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science, Fudan University, Shanghai, China 4: Guangxi Pingguo Center for Disease Control and Prevention, Pingguo, Guangxi 5: Sichuan Wusheng Center for Disease Control and Prevention, Wusheng, Sichuan 6: Chinese Center for Disease Control and Prevention, Beijing, China 7: Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science, Fudan University, Shanghai, China 8: Aeras, Rockville, Maryland, USA, The Aurum Institute, Johannesburg, South Africa

Publication date: 01 November 2017

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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