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

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Infectious Diseases of Poverty 2020年第6期9卷 16-28页

作者： Luan Nguyen Quang Vo Andrew James Codlin Rachel Jeanette Forse NgaThuy Nguyen Thanh Nguyen Vu Giang Truong Le Vinh Van Truong Giang Chau Do Ha Minh Dang Lan Huu Nguyen Hoa Binh Nguyen Nhung Viet Nguyen jens levy Knut Lonnroth SBertel Squire Maxine Caws Friends for International TB Relief 68B Nguyen Van Troi8Phu NhuanHo Chi Minh CityViet Nam Interactive Research and Development Ho Chi Minh CityViet Nam Ho Chi Minh City Public Health Association Ho Chi Minh CityViet Nam Pham Ngoc Thach Hospital Ho Chi Minh CityViet Nam National Lung Hospital Ha NoiViet Nam KNCV Tuberculosefonds The HagueThe Netherlands Department of Global Public Health Karolinska InstitutetStockholmSweden Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK Birat Nepal Medical Trust LazimpatKathmanduNepal

Background: In order to end tuberculosis(TB),it is necessary to expand coverage of TB care services,including systematic screening ***,more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health *** 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 *** persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF *** individuals with normal or without radiography results were tested on smear *** described the TB care cascade and characteristics for each priority group,and calculated yield and number needed to ***,we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment ***: We verbally screened 321020 people including 24232 household contacts,3182 social and close contacts and 293606 residents of urban priority *** resulted in 1138 persons treated for TB,of whom 85 were household contacts,39 were close contacts and 1014 belonged to urban priority area *** yield of active TB in these groups was 351,1226 and 345 per 100000,respectively,corresponding to numbers needed to screen of 285,82 and *** 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 ***: The study detected a large number of un

关键词： Case detection Tuberculosis Active case finding Urban Viet nam

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The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

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Infectious Diseases of Poverty 2019年第6期8卷 61-75页

作者： Suman Chandra Gurung Kritika Dixit Bhola Rai Maxine Caws Puskar Raj Paudel Raghu Dhital Shraddha Acharya Gangaram Budhathoki Deepak Malla jens W.levy Job van Rest Knut Lonnroth Kerri Viney Andrew Ramsay Tom Wingfield Buddha Basnyat Anil Thapa Bertie Squire Duolao Wang Gokul Mishra Kashim Shah Anil Shrestha Noemia Teixeira de Siqueira-Filha Birat Nepal Medical Trust KathmanduNepal Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK KNCV Tuberculosis Foundation The HagueNetherlands Department of Public Health Sciences Karolinska InstitutetStockholmSweden Research School of Population Health Australian National UniversityCanberraAustralia University of St Andrews St AndrewsUK University of Liverpool LiverpoolUK Oxford University Clinical Research Unit KathmanduNepal National Tuberculosis Centre BhaktapurNepal Nick Simons Institute LalitpurNepal Institute for Health Technology Assessment Porto AlegreBrazil

Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by *** role of active case finding(ACF)in reducing patient costs has not been determined *** study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding(PCF),and to determine the prevalence and intensity of patient-incurred catastrophic costs in ***:The study was conducted in two districts of Nepal:Bardiya and Pyuthan(Province No.5)between June and August *** hundred patients were included in this study in a 1:1 ratio(PCF:ACF,25 consecutive ACF and 25 consecutive PCF patients in each district).The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical *** costs were calculated based on the proportion of patients with total costs exceeding 20%of their annual household *** intensity of catastrophic costs was calculated using the positive overshoot *** chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and ***,the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of ***:Ninety-nine patients were interviewed(50 ACF and 49 PCF).Patients diagnosed through ACF incurred lower costs during the pre-treatment period(direct medical:USD 14 vs USD 32,P=0.001;direct non-medical:USD 3 vs USD 10,P=0.004;indirect,time loss:USD 4 vs USD 13,P<0.001).The cost of the pre-treatment and intensive phases combined was also lower for direct medical(USD 15 vs USD 34,P=0.002)and non-medical(USD 30 vs USD 54,P=0.022)costs among ACF *** prevalence of catastrophic direct costs was lower for ACF patients for all thresholds.A lower intensity of catastrophic costs was also documented for ACF patients,altho

关键词： Tuberculosis Case finding Cost Catastrophic cost Patient-incurred cost Nepal

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