Active case detection methods for crusted scabies and leprosy: A systematic review

Abstract

Background Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. Methods and principle findings We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. Conclusion This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.

Effectiveness of community-based burden estimation to achieve elimination of lymphatic filariasis: A comparative cross-sectional investigation in Côte d’Ivoire

“…We believe the financial cost per person screened in our study was low from an NTD programmatic perspective, being comparable to the cost per person treated through MDA in African settings in the early 2000's [33], and substantially lower than the cost per person examined in the global trachoma mapping project ($4.20 in Co ˆte d'Ivoire in 2015) [34]. The cost per case confirmed was lower than published estimates of the cost per case found in community-based leprosy screening, varying from $72 (in Mali, 1999)-$313 (in Nigeria, 2002) [35]. The costs were also low relative to the financial burden on patients unable to work due to LFM, estimated at around $700 per individual affected [36], and costing almost $1.3 billion a year in lost productivity globally [37].…”

Effectiveness of community-based burden estimation to achieve elimination of lymphatic filariasis: a comparative cross-sectional investigation in Côte d’Ivoire

“…We believe the financial cost per person screened in our study was low from an NTD programmatic perspective, being comparable to the cost per person treated through MDA in African settings in the early 2000’s [34], and substantially lower than the cost per person examined in the global trachoma mapping project ($4.20 in Côte d’Ivoire in 2015) [35]. The cost per case confirmed was lower than published estimates of the cost per case found in community-based leprosy screening, varying from $72 (in Mali, 1999)-$313 (in Nigeria, 2002) [36]. The costs were also low relative to the financial burden on patients unable to work due to LFM, estimated at around $700 per individual affected [37], and costing almost $1.3 billion a year in lost productivity globally [38].…”

Recommendations for an Optimal Model of integrated case detection, referral, and confirmation of Neglected Tropical Diseases: A case study in Bong County, Liberia

“…Several studies have been conducted on the integrated case management of NTDs strategy in Liberia, focusing on patient perception, the outcome of care, and case detection (22,25,26). There have been findings on the effectiveness of active case search in increasing the number of cases compared to reliance on passive surveillance at the health facility for specific diseases (27,28). However, the findings from this study support improved access to care for affected persons through early case detection.…”