Optimizing the efficiency of tuberculosis active case-finding in health facilities and communities
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.
Document Type: Research Article
Affiliations: 1: Harvard Medical School, Boston, MA, USA 2: Kenya Medical Research Institute, Kisumu 3: Kenya Medical Research Institute, US Army Medical Research Directorate—Kenya, Kisumu 4: US Army Medical Research Directorate—Kenya, Kisumu, Kenya 5: Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA 6: CDC—Kenya, Kisumu, Kenya
Publication date: July 1, 2019
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