Abstract

Background: Community-based active case finding (ACF) for tuberculosis (TB) implemented among marginalised and vulnerable populations in 285 districts of India resulted in reduction of diagnosis delay and prevalence of catastrophic costs due to TB diagnosis. We were interested to know whether this translated into improved treatment outcomes. Globally, there is limited published literature from marginalised and vulnerable populations on the independent effect of community-based ACF on treatment outcomes when compared to passive case finding (PCF).

Objectives: To determine the relative differences in unfavourable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) of ACF and PCF-diagnosed people.

Methods: Cohort study involving record reviews and interviews in 18 randomly selected districts. We enrolled all ACF-diagnosed people with new smear-positive pulmonary TB, registered under the national TB programme between March 2016 and February 2017, and an equal number of randomly selected PCF-diagnosed people in the same settings. We used log binomial models to adjust for confounders.

Results: Of 572 enrolled, 275 belonged to the ACF and 297 to the PCF group. The proportion of unfavourable outcomes were 10.2% (95% CI: 7.1%, 14.3%) in the ACF and 12.5% (95% CI: 9.2%, 16.7%) in the PCF group (p = 0.468). The association between ACF and unfavourable outcomes remained non-significant after adjusting for confounders available from records [aRR: 0.83 (95% CI: 0.56, 1.21)]. Due to patient non-availability at their residence, interviews were conducted for 465 (81.3%). In the 465 cohort too, there was no association after adjusting for confounders from records and interviews [aRR: 1.05 (95% CI: 0.62, 1.77)].

Conclusion: We did not find significant differences in the treatment outcomes. Due to the wide CIs, studies with larger sample sizes are urgently required. Studies are required to understand how to translate the benefits of ACF to improved treatment outcomes.

Details

Title
Active versus passive case finding for tuberculosis in marginalised and vulnerable populations in India: comparison of treatment outcomes
Author
Hemant Deepak Shewade 1   VIAFID ORCID Logo  ; Gupta, Vivek 2 ; Satyanarayana, Srinath 3 ; Kumar, Sunil 4 ; Pandey, Prabhat 5 ; Bajpai, U N 6 ; Jaya Prasad Tripathy 7   VIAFID ORCID Logo  ; Soundappan Kathirvel 8 ; Pandurangan, Sripriya 5 ; Mohanty, Subrat 5 ; Ghule, Vaibhav Haribhau 9   VIAFID ORCID Logo  ; Sagili, Karuna D 5 ; Banuru Muralidhara Prasad 5 ; Singh, Priyanka 10 ; Singh, Kamlesh 11 ; Jayaraman, Gurukartick 12 ; Rajeswaran, P 12 ; Biswas, Moumita 5 ; Mallick, Gayadhar 5 ; Ali Jafar Naqvi 10   VIAFID ORCID Logo  ; Bharadwaj, Ashwin Kumar 11 ; Sathiyanarayanan, K 12 ; Pathak, Aniruddha 5 ; Mohan, Nisha 13 ; Rao, Raghuram 14 ; Kumar, Ajay M V 15   VIAFID ORCID Logo  ; Sarabjit Singh Chadha 16 

1  Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; Department of Operational Research, The Union South-East Asia (USEA), New Delhi, India; Karuna Trust, Bengaluru, India 
2  Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India 
3  Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France 
4  State TB Cell, Department of Health & Family Welfare, Government of Kerala, Thiruvananthapuram, India 
5  Department of TB and Communicable Diseases, The Union South-East Asia (USEA), New Delhi, India 
6  Voluntary Health Association of India (VHAI), New Delhi, India 
7  Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; Department of Operational Research, The Union South-East Asia (USEA), New Delhi, India 
8  Department of Operational Research, The Union South-East Asia (USEA), New Delhi, India; Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India 
9  Joint Efforts for Elimination of TB (JEET) Project, Foundation for Innovate New Diagnostics (FIND), New Delhi, India 
10  MAMTA Health Institute for Mother and Child, New Delhi, India 
11  Catholic Health Association of India (CHAI), Telangana, India 
12  Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India 
13  Karuna Trust, Bengaluru, India; IIHMR University, Jaipur, India 
14  Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare, Government of India, New Delhi, India 
15  Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; Department of Operational Research, The Union South-East Asia (USEA), New Delhi, India; Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India 
16  Infectious Diseases, Foundation for Innovate New Diagnostics (FIND), New Delhi, India 
Publication year
2019
Publication date
2019
Publisher
Taylor & Francis Ltd.
e-ISSN
16549880
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1080/16549716.2019.1656451
ProQuest document ID
2351041355
Copyright
© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This work is licensed under the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.