Community active case finding for pulmonary tuberculosis

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand | 2019 Background: The World Health Organization (WHO) has implemented a policy of active case findings for tuberculosis (TB) to achieve the End TB Strategy, a world free of TB, by 2035. However, early case detection in Thailand, a high TB-burden country, is not presently routinely applied. Objective: To demonstrate a model for, and the feasibility of, active TB case detection in Thailand. Materials and Methods: The present study was a cross-sectional study of a mobile-outreach survey conducted in Hua Hin District, Prachuap Khiri Khan Province. Adult Thai participants were assessed for TB risk factors, symptoms, and signs, and onsite chest X-rays (CXRs) were performed. Pulmonologists identified individuals with suspected active TB and referred them to hospital. Results: The findings of 21 out of 858 participants (2.4%) were classified as highly suspicious of TB. Any one of a chronic cough, constitutional symptoms, a history of household TB contact, and an abnormality on a CXR raised the possibility of TB (odds ratio of 4.07, 4.60, 3.68, and 1.30 respectively). Anti-TB therapy was prescribed for seven individuals following hospital-based assessments (0.8% of the study population; two smear-positives and five smear-negatives). However, one quarter of the 21 screen-positive participants did not contact the local health authority for further evaluation to confirm the diagnosis. Conclusion: The mobile-outreach TB screening, which utilized a questionnaire and CXR, proved to be practical. Including migrant employees in the screening program and enhancing public awareness may strengthen the program.