Yield of intensified tuberculosis case-finding activities using Xpert® MTB/RIF among risk groups in Nepal
Objectives: To assess the yield of TB screening using an algorithm with smear microscopy followed by Xpert® MTB/RIF.
Design: A descriptive study using routinely collected data.
Results: Of 145 679 individuals screened, 28 574 (19.6%) had presumptive TB; 1239 (4.3%) of these were diagnosed with TB and 1195 (96%) were initiated on anti-tuberculosis treatment. The yield of screening was highest among people living with the human immunodeficiency virus (PLHIV) (6.1%), followed by household contacts (3.5%) and urban slum dwellers (0.5%). Among other risk groups, such as prisoners, factory workers, refugees and individuals with diabetes, the yield was less than 0.5%. The number needed to screen to diagnose an active TB case was 17 for PLHIV, 29 for household contacts and 197 for urban slum dwellers. Of 11 525 patients from ICF and the routine programme, 112 (1%) were diagnosed with multidrug-resistant TB.
Conclusion: There was a substantial yield of TB cases among risk groups such as PLHIV and household contacts. Although the yield in urban slum dwellers was found to be moderate, some intervention should nonetheless be targeted because of the large population and poor access to care in this group.
Keywords: TB REACH; number needed to screen; operational research; systematic screening
Document Type: Research Article
Affiliations: 1: Health Research and Social Development Forum (HERD), Kathmandu, Nepal 2: National Tuberculosis Centre, Thimi, Bhaktapur, Nepal 3: Nuffield Centre for International Health and Development, Leeds Institute of Health Science, Leeds, UK 4: PHTB Consult, Tilburg, The Netherlands 5: Post Graduate Institute of Medical Education and Research, Chandigarh, India 6: Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Publication date: June 21, 2016
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