Impact of intensified case-finding strategies on childhood TB case registration in Nepal

Joshi, Basant; Chinnakali, Palanivel; Shrestha, Asmita; Das, Mrinalini; Kumar, Anil; Pant, Rashmi; Lama, Rajesh; Sarraf, R. R.; Dumre, Shyam Prakash; Harries, Anthony

doi:10.5588/pha.15.0004

Cited by 25 publications

(30 citation statements)

References 17 publications

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“…Studies from Pakistan, India, Nepal and Nigeria have shown that intensified case finding can result in large increases in childhood TB case notification [9,[13][14][15]. Our study indicates that injection of new resources through focused active TB case finding and contact tracing efforts can substantially raise the baseline TB case notification among children.…”

Section: Discussionmentioning

confidence: 61%

The Impact of Funding on Childhood TB Case Detection in Pakistan

Malik

Hussain²,

Creswell³

et al. 2019

TropicalMed

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This study is a review of routine programmatically collected data to describe the 5-year trend in childhood case notification in Jamshoro district, Pakistan from January 2013 to June 2018 and review of financial data for the two active case finding projects implemented during this period. The average case notification in the district was 86 per quarter before the start of active case finding project in October 2014. The average case notification rose to 322 per quarter during the implementation period (October 2014 to March 2016) and plateaued at 245 per quarter during the post-implementation period (April 2016 to June 2018). In a specialized chest center located in the district, where active case finding was re-introduced during the post implementation period (October 2016), the average case notification was 218 per quarter in the implementation period and 172 per quarter in the post implementation period. In the rest of the district, the average case notification was 160 per quarter in the implementation period and 78 during the post implementation period. The cost per additional child with TB found ranged from USD 28 to USD 42 during the interventions. A continuous stream of resources is necessary to sustain high notifications of childhood TB.

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Section: Discussionmentioning

confidence: 61%

The Impact of Funding on Childhood TB Case Detection in Pakistan

Malik

Hussain²,

Creswell³

et al. 2019

TropicalMed

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“…Hence, ACF affords a high yield HIV testing platform to help achieve the universal target of diagnosing 90% of all people living with HIV. [18] Unfortunately, limited data is available to inform ACF in children living in TB/HIV-high burden settings [9, 12, 14]. Implemented in a setting with extremely high TB and HIV infection rates, our pediatric-focused contact tracing program demonstrated that the yield of contact tracing is 1.43 fold greater in HIV-affected households.…”

Section: Discussionmentioning

confidence: 99%

“…Despite numerous peer-reviewed articles documenting that household proximity to a bacteriologically confirmed adult TB is an important predictor of a positive TB screen in children, there is very little published data on ACF interventions targeting childhood TB in TB high-burden, resource-limited settings [12, 13]. Gaps in the literature regarding the childhood TB diagnostic cascade include limited evidence to inform standardized childhood TB contact tracing algorithms or to improve the diagnosis of paucibacillary TB in children [14]. As there is little evidence available regarding the yield of household contact and source case investigations among children in TB/HIV high burden settings, the objective of our study was to evaluate the yield and additionality of these strategies in a TB/HIV high burden setting while prioritizing the identification of TB among child contacts.…”

Section: Introductionmentioning

confidence: 99%

BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing

et al. 2017

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BackgroundLimited data exists to inform contact tracing guidelines in children and HIV-affected populations. We evaluated the yield and additionality of household contact and source case investigations in Swaziland, a TB/HIV high-burden setting, while prioritizing identification of childhood TB.MethodsIn partnership with 7 local TB clinics, we implemented standardized contact tracing of index cases (IC) receiving TB treatment. Prioritizing child contacts and HIV-affected households, screening officers screened contacts for TB symptoms and to identify risk factors associated with TB. We ascertained factors moderating the yield of contact tracing and measured the impact of our program by additional notifications.ResultsFrom March 2013 to November 2015, 3,258 ICs (54% bacteriologically confirmed; 70% HIV-infected; 85% adults) were enrolled leading to evaluation of 12,175 contacts (median age 18 years, IQR 24–42; 45% children; 9% HIV-infected). Among contacts, 196 TB cases (56% bacteriologically confirmed) were diagnosed resulting in a program yield of 1.6% for all forms of TB. The number needed to screen (NNS) to identify a bacteriologically confirmed TB case or all forms TB case traced from a child IC <5 years was respectively 62% and 40% greater than the NNS for tracing from an adult IC. In year one, we demonstrated a 32% increase in detection of bacteriologically confirmed child TB. Contacts were more likely to have TB if <5 years (OR = 2.0), HIV-infected (OR = 4.9), reporting ≥1 TB symptoms (OR = 7.7), and sharing a bed (OR = 1.7) or home (OR = 1.4) with the IC. There was a 1.4 fold increased chance of detecting a TB case in households known to be HIV-affected.ConclusionContact tracing prioritizing children is not only feasible in a TB/HIV high-burden setting but contributes to overall case detection. Our findings support WHO guidelines prioritizing contact tracing among children and HIV-infected populations while highlighting potential to integrate TB and HIV case finding.

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“…16 The impact of the ICF activities in several districts on improving childhood TB CNR was documented recently in Nepal. 17 However, ZAMSTAR, a community-randomised trial in Zambia and the Western Cape province of South Africa, showed that neither community-level enhanced TB case finding nor household level TB-HIV care led to a statistically significant reduction in the TB burden in the community. It is important to note that the trial involved only enhanced case finding, and not systematic screening (active screening), as was done in the present study.…”

Section: Public Health Actionmentioning

confidence: 99%

Yield of intensified tuberculosis case-finding activities using Xpert^® MTB/RIF among risk groups in Nepal

Khanal¹,

Baral²,

Shrestha³

et al. 2016

public health action

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Impact of intensified case-finding strategies on childhood TB case registration in Nepal

Abstract: A package of intensified case-finding strategies in children was associated with an increase in childhood TB case registrations in Nepal. Additional diagnostic approaches to increase case registrations also need to be considered.

Cited by 25 publications

References 17 publications

The Impact of Funding on Childhood TB Case Detection in Pakistan

The Impact of Funding on Childhood TB Case Detection in Pakistan

BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing

Yield of intensified tuberculosis case-finding activities using Xpert^® MTB/RIF among risk groups in Nepal

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Impact of intensified case-finding strategies on childhood TB case registration in Nepal

Abstract: A package of intensified case-finding strategies in children was associated with an increase in childhood TB case registrations in Nepal. Additional diagnostic approaches to increase case registrations also need to be considered.

Cited by 25 publications

References 17 publications

The Impact of Funding on Childhood TB Case Detection in Pakistan

The Impact of Funding on Childhood TB Case Detection in Pakistan

BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing

Yield of intensified tuberculosis case-finding activities using Xpert® MTB/RIF among risk groups in Nepal

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Yield of intensified tuberculosis case-finding activities using Xpert^® MTB/RIF among risk groups in Nepal