Framework for planning and monitoring active TB case finding interventions to meet the global targets in the COVID-19 era and beyond: South-East Asia perspective

Abstract

There was an estimated 20–40% decline in tuberculosis (TB) case detection in the South-East Asia Region (SEA Region) during 2020 due to COVID-19 outbreak. This is over and above a million people with TB who were missed each year, prior to the pandemic. Active case finding (ACF) for TB has been gaining considerable interest and investment in the SEA Region and will be even more essential for finding people with TB missed due to the COVID-19 pandemic. Many countries in the Region have incorporated ACF activities into national strategic plans and are conducting large scale activities with varying results. ACF can reach people with TB earlier than routine approaches, can lead to increases in the numbers of people diagnosed, and is often needed for certain key populations who face stigma, social, and economic barriers. However, ACF is not a one size fits all approach, and has higher costs than routine care. So, planning interventions in consultation with relevant stakeholders including the affected communities is critical. Furthermore, continuous monitoring during the intervention and after completion is crucial as national TB programmes review progress and decide on the effective utilization of limited resources. Planning and monitoring become more relevant in the COVID-19 era because of constraints posed by resource diversion towards pandemic control. Here, we summarize different aspects of planning and monitoring of ACF approaches to inform national TB programmes and partners based on experiences in the SEA Region, as programmes look to reach those who are missed and catch-up on progress towards ending TB.

Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019

“…Early ACF programs have recently been strengthened to be more patient-driven due to widespread acceptance and success [ 39 – 42 ]. With the disruption of services due to the COVID-19 pandemic and subsequent reduction in TB case detection in many countries, strategies have been recommended to plan and monitor ACF activities during and beyond the pandemic [ 43 ]. Though early data suggests that the COVID-19 pandemic has resulted in 17,500 excess all-cause deaths in Cambodia [ 44 ], more data are needed to know the long-term impact of the COVID-19 pandemic on TB in Cambodia.…”

Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups – The Romanian Experience

“…Despite the overlap with the pandemic, careful planning ensured continuous case identification. 15 , 16 An example from rural India demonstrated ACF success, identifying over 8700 symptomatic cases among 65,000 individuals, with 17% (964) confirmed positive for TB through smear tests. 17 A separate ACF initiative targeted households in urban slums, tribal areas, and remote rural regions.…”

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

“…By engaging TB patients early in their care journey, ACF programs can address barriers to treatment adherence and facilitate patient-centered care, which are known determinants of treatment success [ 29 , 33 ]. Moreover, ACF activities may contribute to increased awareness and knowledge about TB within the community, leading to reduced stigma, improved health-seeking behavior, and earlier presentation to healthcare facilities among individuals with TB symptoms [ 19 , 24 , 45 , 46 ]. These findings emphasize the critical role of ACF in achieving better TB treatment outcomes, underscoring the need for continued support and implementation of ACF initiatives.…”