Active case-finding to improve tuberculosis control.

Is active case finding necessary to control tuberculosis in developing countries?

Tuberculosis is one of the world’s leading causes of death and disease. Despite effective treatment, tuberculosis still results in several million deaths each year. Reducing the burden of global TB disease is a part the Millennium Development Goals. Earlier, health authorities thought that DOTS (Direct Observed Treatment, Short course) would control tuberculosis. However, we now recognize that DOTS alone is unable of reducing TB incidence in high endemic countries.

Active case finding is to find, diagnose, and treat and follow up tuberculosis patients in the local communities.

To find out the efficacy of community-based case finding, we did a community randomized trial and cost-effectiveness analysis in south Ethiopia. The trial Ethiopia aimed to evaluate if community health workers could improved smear-positive case detection and treatment success rates (Datiko and Lindtjørn, 2009 and Datiko and Lindtjørn, 2010).

The study showed that involving of health extension workers (HEWs) in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This finding has policy implications and could be applied in settings with low health service coverage and a shortage of health workers.

Recently, National TB Control Programme in Ethiopia started to decentralize case finding and treatment to local communities (in Ethiopia called kebeles) using community based-treatment by health extension workers.

We plan to follow up our earlier studies and develop a model for community DOTS in rural Ethiopia. We aim to improve the community-based implementation of case finding and treatment of TB in rural settings of southern Ethiopia. This will try to develop community-based tuberculosis registries, and registries of patients with symptoms suggestive of tuberculosis.  Through this work we aim to see if case finding and treatment outcomes can be improved on a larger scale and involving larger populations

Datiko, D., & Lindtjørn, B. (2009). Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial PLoS ONE, 4 (5) DOI: 10.1371/journal.pone.0005443

Datiko, D., & Lindtjørn, B. (2010). Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia: An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial PLoS ONE, 5 (2) DOI: 10.1371/journal.pone.0009158

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