Active case-finding for tuberculosis in India

Giridharan, Prathiksha; Daniel, B; Natrajan, Mohan

doi:10.4103/0970-258x.275349

Cited by 12 publications

(6 citation statements)

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“…The observed enhancement in treatment outcomes associated with ACF in our study can be attributed to several potential mechanisms. Firstly, ACF facilitates the early detection of TB cases within the community [ 13 , 21 ], enabling prompt initiation of treatment [ 12 ]. By actively screening individuals who may not present with typical TB symptoms but are still infectious, ACF minimizes delays in diagnosis and treatment initiation [ 19 , 42 , 43 ], crucial factors in preventing disease progression and transmission [ 6 , 8 , 25 , 39 , 44 ], ultimately reducing morbidity, mortality, and the overall burden of TB.…”

Section: Discussionmentioning

confidence: 99%

“…By actively screening individuals who may not present with typical TB symptoms but are still infectious, ACF minimizes delays in diagnosis and treatment initiation [ 19 , 42 , 43 ], crucial factors in preventing disease progression and transmission [ 6 , 8 , 25 , 39 , 44 ], ultimately reducing morbidity, mortality, and the overall burden of TB. Additionally, ACF allows for the identification of TB cases at an earlier stage of the disease, when treatment is more effective and complications are less likely to occur [ 21 , 25 , 42 , 44 , 45 ]. This early detection and treatment initiation may contribute to a higher proportion of cases achieving cure status, thereby improving treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies in India have reported varying rates of TB positivity through ACF, ranging from as low as 0.17% among migrant workers to 17% overall [ 19 , 20 ]. Primarily, studies have emphasized the increase in TB case detection yields through ACF [ 21 ]. Additionally, research has focused on documenting the outcomes of contact investigations, revealing rates as high as 5% in southern India and 1.5% in remote tribal areas [ 19 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India

Shah,

Dave,

Makwana

et al. 2024

Arch Public Health

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Background Tuberculosis (TB) remains a significant public health burden in India, with elimination targets set for 2025. Active case finding (ACF) is crucial for improving TB case detection rates, although conclusive evidence of its association with treatment outcomes is lacking. Our study aims to investigate the impact of ACF on successful TB treatment outcomes among pulmonary TB patients in Gujarat, India, and explore why ACF positively impacts these outcomes. Methods We conducted a retrospective cohort analysis in Gujarat, India, including 1,638 pulmonary TB cases identified through ACF and 80,957 cases through passive case finding (PCF) from January 2019 to December 2020. Generalized logistic mixed-model compared treatment outcomes between the ACF and PCF groups. Additionally, in-depth interviews were conducted with 11 TB program functionaries to explore their perceptions of ACF and its impact on TB treatment outcomes. Results Our analysis revealed that patients diagnosed through ACF exhibited 1.4 times higher odds of successful treatment outcomes compared to those identified through PCF. Program functionaries emphasized that ACF enhances case detection rates and enables early detection and prompt treatment initiation. This early intervention facilitates faster sputum conversion and helps reduce the infectious period, thereby improving treatment outcomes. Functionaries highlighted that ACF identifies TB cases that might otherwise be missed, ensuring timely and appropriate treatment. Conclusion ACF significantly improves TB treatment outcomes in Gujarat, India. The mixed-methods analysis demonstrates a positive association between ACF and successful TB treatment, with early detection and prompt treatment initiation being key factors. Insights from TB program functionaries underscore the importance of ACF in ensuring timely diagnosis and treatment, which are critical for better treatment outcomes. Expanding ACF initiatives, especially among hard-to-reach populations, can further enhance TB control efforts. Future research should focus on optimizing ACF strategies and integrating additional interventions to sustain and improve TB treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India

Shah,

Dave,

Makwana

et al. 2024

Arch Public Health

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“…Active case finding is the best approach for finding new cases in vulnerable populations and helps in the reduction of the incidence of tuberculosis. [ 4 ] The vulnerable groups like tribal, migrants, nomads and semi-nomads are often left out and less focused due to their dynamic mobility and lack of awareness among them. Most of the time the reason for poor diagnosis and variability in prevalence was due to the poor representation among tribal people, migrants and nomadic people.…”

Section: Introductionmentioning

confidence: 99%

Active case finding of tuberculosis among nomads and semi-nomads in Puducherry

Ramalingam,

Senthil,

Dhasaram

et al. 2024

Journal of Family Medicine and Primary Care

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Context: Tuberculosis (TB), is a global epidemic and communicable disease that accounts for increased global mortality and morbidity. India is also marching towards the elimination of tuberculosis by 2025 with this background we conducted this study. Aims: To identify the undiagnosed TB cases in nomadic and semi-nomadic populations of Puducherry. Settings and Design: A community-based cross-sectional study was done among nomads and semi-nomads in Puducherry for four months between May 2022 to September 2022 after getting the Institute’s ethical committee approval. Methods and Material: After obtaining written consent/assent, a pretested semi structured questionnaire was used to record the data. The questionnaire consists of three parts that include, sociodemographic details and history specific to tuberculosis based on operational definitions such as presumptive TB and physical examination. Those participants fulfilling the criteria for presumptive TB was provided a Falcon tube for spot sample. The participants were explained the procedure to collect the sputum and its quality was verified by the principal investigator before sending it to the laboratory. Statistical analysis used: Data was analysed with Statistical Package for Social Science (SPSS Inc, Chicago, Illinois, USA) software version 16.0 and Microsoft Excel 2016. Frequencies and percentages were estimated for categorical data. Results: Our study showed 6.25% was the proportion of presumptive TB cases in our study population. In the presumptive TB cases 60% belonged to age >45yrs 80% belonged to the male gender and all of them belonged to lower socioeconomic status. The macro-environment findings of those presumptive TB cases were 80% belonged Kutcha houses, with poor ventilation and overcrowding present. Their co-morbidity status indicates 60% were diabetics and 20% were hypertensive. Their predominant findings were 80% reported Cough and 20% fever, significant weight loss. No contact history of TB was found. When these presumptive TB cases underwent microbiological examination, none were sputum positive. Conclusions: This study showed ACF helped to identify presumptive TB in an effective way and needs large-scale screening to identify sputum-positive cases.

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“…Since this baseline study, there have been numerous attempts to engage pharmacists in TB care, treatment education, and screening and referral [1,[19][20][21][22][23], and while this study was not aimed to parse out the individual impact of each respective intervention, we did expect them to have changed practice amongst pharmacists in these settings to some extent.…”

Section: Introductionmentioning

confidence: 99%

Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study

Svadzian

Daniels

Sulis

et al. 2023

PLOS Glob Public Health

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As the first point of care for many healthcare seekers, private pharmacies play an important role in tuberculosis (TB) care. However, previous studies in India have showed that private pharmacies commonly dispense symptomatic treatments and broad-spectrum antibiotics over-the-counter (OTC), rather than referring patients for TB testing. Such inappropriate management by pharmacies can delaye TB diagnosis. We assessed medical advice and OTC drug dispensing practices of pharmacists for standardized patients presenting with classic symptoms of pulmonary TB (case 1) and for those with sputum smear positive pulmonary TB (case 2), and examined how practices have changed over time in an urban Indian site. We examined how and whether private pharmacies improved practices for TB in 2019 compared to a baseline study conducted in 2015 in the city of Patna, using the same survey sampling techniques and study staff. The proportion of patient-pharmacist interactions that resulted in correct or ideal management, as well as the proportion of interactions resulting in antibiotic, quinolone, and corticosteroid are presented, with standard errors clustered at the provider level. To assess the difference in case management and the use of drugs across the two cases by round, a difference in difference (DiD) model was employed. A total of 936 SP interactions were completed over both rounds of survey. Our results indicate that across both rounds of data collection, 331 of 936 (35%; 95% CI: 32–38%) of interactions were correctly managed. At baseline, 215 of 500 (43%; 95% CI: 39–47%) of interactions were correctly managed whereas 116 of 436 (27%; 95% CI: 23–31%) were correctly managed in the second round of data collection. Ideal management, where in addition to a referral, patients were not prescribed any potentially harmful medications, was seen in 275 of 936 (29%; 95% CI: 27–32%) of interactions overall, with 194 of 500 (39%; 95% CI: 35–43%) of interactions at baseline and 81 of 436 (19%; 95% CI: 15–22%) in round 2. No private pharmacy dispensed anti-TB medications without a prescription. On average, the difference in correct case management between case 1 vs. case 2 dropped by 20 percent points from baseline to the second round of data collection. Similarly, ideal case management decreased by 26 percentage points between rounds. This is in contrast with the dispensation of medicines, which had the opposite effect between rounds; the difference in dispensation of quinolones between case 1 and case 2 increased by 14 percentage points, as did corticosteroids by 9 percentage points, antibiotics by 25 percentage points and medicines generally by 30 percentage points. Our standardised patient study provides valuable insights into how private pharmacies in an Indian city changed their management of patients with TB symptoms or with confirmed TB over a 5-year period. We saw that overall, private pharmacy performance has weakened over time. However, no OTC dispensation of anti-TB medications occurred in either survey round. As the first point of contact for many care seekers, continued and sustained efforts to engage with Indian private pharmacies should be prioritized.

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Active case-finding for tuberculosis in India

Cited by 12 publications

References 0 publications

A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India

A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India

Active case finding of tuberculosis among nomads and semi-nomads in Puducherry

Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study

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