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

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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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Keywords: Kenya; health facilities; mobile health units; symptom assessment

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

More about this publication?
  • 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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