A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam

Abstract

Background: To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale-up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies. Methods: We conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications. Results: We verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021).

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

“…These seven districts were selected for inclusion in a two-year, controlled evaluation study comparing the performance of different community healthcare worker (CHW) employment models on the yields, impact and cost of community-based active TB case-finding due to their low case detection and notification rates [ 19 ]. In this evaluation study, CHWs screened household contacts and other urban priority groups for symptoms of TB and made referrals for facility-based CXR screening services and follow-on diagnostic testing [ 20 ].…”

Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City, Viet Nam

“…Each intervention district’s local health authorities recruited a cadre of CHW as incentivized volunteers or salaried employees. The differences of these engagement models have been described elsewhere [ 28 ]. These CHWs conducted contact investigation and door-to-door screening.…”

The TB REACH Initiative: Supporting TB Elimination Efforts in the Asia-Pacific

“…The continued monitoring and evaluation of TB REACH interventions ensures an understanding of the target populations demographics and specifically, how many people are reached, screened, tested and diagnosed, and where people drop out of the care cascade. A number of mobile screening applications to track people through the care cascade as well as systems to track Xpert testing have been developed [ 31 , 32 ].…”