A structured 2-week follow-up visit in the cascade of care for TB increases case detection

• Published in: The international journal of tuberculosis and lung disease Vol. 28; no. 3; pp. 148 - 153
• Main Authors: Rudolf, F., Abate, E., Moges, B., Gomes, V. F., Mendes, A. M., Sifna, A., Fekadu, H., Bizuneh, S., Wejse, C., Schön, T.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01-03-2024; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Adult; Cascade Of Care; Case-Finding; Cough; Delivery of Health Care; Diagnosis; Diagnostic systems; Disease transmission; Epidemiology; Ethiopia; Follow-Up Studies; Health care facilities; Humans; Medical diagnosis; Medical screening; Morbidity; Mycobacterium tuberculosis; Patients; Signs and symptoms; Tbscore; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - prevention & control; Ethiopia; Guinea Bissau; epidemiology; TBscore; cascade of care; case-finding; tuberculosis
• ISSN: 1027-3719; 1815-7920; 1815-7920
• DOI: 10.5588/ijtld.23.0435

OBJECTIVES Delayed detection in TB due to structural and diagnostic shortcomings is pivotal for disease transmission, morbidity and mortality. We investigated whether an inclusive screening, followed by a structured clinical follow-up
(FU) could improve case-finding. METHODS Patients were recruited from health centres in Bissau, Guinea-Bissau, and Gondar, Ethiopia. A routine FU was done at Week 2. If persisting symptoms were found, patients were investigated
using chest X-ray (CXR) and Xpert® MTB/RIF, followed by a medical consultation. The main outcome were additional TB patients diagnosed by applying the FU strategy. RESULTS Of 3,571 adults, 3,285 (95%) were examined
at Week 2 FU, where 2,491 (72%) were asymptomatic. Screening patients presenting with cough >2 weeks alone contributed to the diagnosis of 93 patients (45% of all patients diagnosed here), whereas a TBscore >3 increased this by 18 (9%); adding a Week 2 FU yielded an additional 94 (46%)
patients. Among the 794 (24%) with persisting symptoms, 25 were diagnosed using Xpert and 69 at clinical FU, which constituted 46% (94/205) of the total TB patients diagnosed. CONCLUSION A Week 2 FU visit, which can be nested
into routine healthcare, increased the diagnosis of TB patients by two-fold and avoids diagnostic gaps in the cascade-of-care.