Optimizing community screening for tuberculosis: Spatial analysis of localized case finding from door-to-door screening for TB in an urban district of Ho Chi Minh City, Viet Nam

Vo, Luan Nguyen Quang; Vu, Thanh Tung; Nguyen, Hoa Trung; Truong, Thanh-Dat; Khuu, Canh Minh; Pham, Phuong Quoc; Nguyen, Lan Huu; Le, Giang Truong; Creswell, Jacob

doi:10.1371/journal.pone.0209290

Cited by 19 publications

(20 citation statements)

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“…This is concordant with prior analysis showing the relevance of neighborhood contacts as potentially vulnerable populations for targeted screening [31,32]. A prior analysis has shown that the ability to identify hotspots a priori can significantly improve door-to-door screening yield in catchment areas around index cases [26]. As such, door-to-door screening in neighborhoods that house both an index case and a referred neighborhood contact may be a way to sustain high yields while expanding coverage.…”

Section: Discussionsupporting

confidence: 81%

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

Vo¹,

Codlin²,

Forse³

et al. 2020

Infect Dis Poverty

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Background In order to end tuberculosis (TB), it is necessary to expand coverage of TB care services, including systematic screening initiatives. However, more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health Organization. This study evaluated concurrent screening in multiple target groups using community health workers (CHW). Methods In our two-year intervention study lasting from October 2017 to September 2019, CHWs in six districts of Ho Chi Minh City, Viet Nam verbally screened three urban priority groups: (1) household TB contacts; (2) close TB contacts; and (3) residents of urban priority areas without clear documented exposure to TB including hotspots, boarding homes and urban slums. Eligible persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF assay. Symptomatic individuals with normal or without radiography results were tested on smear microscopy. We described the TB care cascade and characteristics for each priority group, and calculated yield and number needed to screen. Subsequently, we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment initiation. Results We verbally screened 321 020 people including 24 232 household contacts, 3182 social and close contacts and 293 606 residents of urban priority areas. This resulted in 1138 persons treated for TB, of whom 85 were household contacts, 39 were close contacts and 1014 belonged to urban priority area residents. The yield of active TB in these groups was 351, 1226 and 345 per 100 000, respectively, corresponding to numbers needed to screen of 285, 82 and 290. The fitted model showed that close contacts [adjusted odds ratio (aOR) = 2.07; 95% CI: 1.38–3.11; P < 0.001] and urban priority area residents (aOR = 2.18; 95% CI: 1.69–2.79; P < 0.001) had a greater risk of active TB than household contacts. Conclusions The study detected a large number of unreached persons with TB, but most of them were not among persons in contact with an index patient. Therefore, while programs should continue to optimize screening in contacts, to close the detection gap in high TB burden settings such as Viet Nam, coverage must be expanded to persons without documented exposure such as residents in hotspots, boarding homes and urban slums.

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Section: Discussionsupporting

confidence: 81%

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

Vo¹,

Codlin²,

Forse³

et al. 2020

Infect Dis Poverty

Self Cite

View full text Add to dashboard Cite

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“…The project also emphasis on the importance of detecting disease and promoting a joined up One Health approach to be re ected in the creation of some new collaborative networks regionally and globally (48). The establishments of an Inter-departmental and coordination group for high containment facilities is highly needed to develop and have global approach to the procurement of evidence for tuberculosis as stated by (49). The Project also can be credited with the importance that issues concerning the emergence of tuberculosis in Africa should be seen as a global public good, therefore, the extension of the project into Africa was a novel and previously unexplored idea, which in turn will lead to the support and creation of African Centre for Tuberculosis Surveillance directed by African Project team members(50, 51).…”

Section: Discussionmentioning

confidence: 99%

Innovative Strategies for Developing Tuberculosis Implementation Research in Sudan

Elshayeb

Ahmed

Salih

et al. 2020

Preprint

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Introduction: Sudan, especially Eastern States are very poor areas at great risk of endemic and communicable diseases particularly tuberculosis. The reasons for the spread and transmission of this disease include medical, economical and geographical issues, besides Sudan’s location in the middle of nine countries in East Africa, its boundaries were affected by free movement, high number of conflicts displaced peoples from boarders’ countries, high illiteracy rates, limited financial resources and shortages in medical services. Objectives: This project is conducted to implement a new developed system for eliminating Tuberculosis infections among eastern Sudanese populations focusing on the eradication of multidrug resistant Mycobacterium tuberculosis including novel methods for the targeted delivery of new therapeutic drugs. Methods: Strategies adopted in this work are proposed to increase access includes to communicable and economic factors. Disease Survey and Laboratorial Investigation for Multi Drug Resistant bacterial strains confirmation. Medical Assessment of TB Patients to facilitate improved efficiencies through metric measurement and enable patients’ relationship management. Established a national level policy of treatment, vaccination and prevention. Administering regular evaluation of the disease situation and control.Results: Implementation outcomes includes the conceptual framework for this project were informed by a combination of the general program logic model, the health system framework of the World Health Organization, WHO, the pillars of the Sudan health agenda, and the framework of the Strategic Elimination Plan. It is assumed that the reduction of TB burden at the national level (long-term output or impact) is preceded by improved case-finding and case-holding practices (short-term output). Impact outcome of the project is derived from the observation that tuberculosis is much more common at the boarders than center of Sudan where no adequate clinical services are available. It is conceivable that, although outbreaks may occur periodically, the control of disease might be easier to overcome than direct medication.Conclusion: A major success of the project accomplishment, is the stimulation of the implementation strategy development for elimination and eradication of Tuberculosis in Sudan with a view to bring diagnostic and surveillance issues much higher up according to the implementation research agenda especially for those areas explored with similar national and international research projects, reports and technical initiatives.

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“…Close contacts were persons that interacted with an index patient at least once per month over the past 3 months. Proximity was defined as the same administrative neighborhood or in a 50 m catchment area around the residence of the index case [27]. We used United Nations Habitat definitions for slum households [28].…”

Section: Interventionmentioning

confidence: 99%

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

Vo¹,

Forse²,

Codlin³

et al. 2020

BMC Public Health

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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).

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Optimizing community screening for tuberculosis: Spatial analysis of localized case finding from door-to-door screening for TB in an urban district of Ho Chi Minh City, Viet Nam

Cited by 19 publications

References 80 publications

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

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

Innovative Strategies for Developing Tuberculosis Implementation Research in Sudan

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

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