Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention
Abstract Background Strategies to identify and treat undiagnosed prevalent cases that have not sought diagnostic services on their own, are necessary to treat TB in patients earlier and interrupt transmission. Late presentation for medical services of symptomatic patients require special efforts to...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-12-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3786-2 |
| _version_ | 1818522103903682560 |
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| author | Esther Karamagi Simon Sensalire Martin Muhire Herbert Kisamba John Byabagambi Mirwais Rahimzai Frank Mugabe Upenytho George Jacqueline Calnan Dejene Seyoum Estella Birabwa |
| author_facet | Esther Karamagi Simon Sensalire Martin Muhire Herbert Kisamba John Byabagambi Mirwais Rahimzai Frank Mugabe Upenytho George Jacqueline Calnan Dejene Seyoum Estella Birabwa |
| author_sort | Esther Karamagi |
| collection | DOAJ |
| description | Abstract Background Strategies to identify and treat undiagnosed prevalent cases that have not sought diagnostic services on their own, are necessary to treat TB in patients earlier and interrupt transmission. Late presentation for medical services of symptomatic patients require special efforts to detect early and notify TB in high risk populations. An intervention that combined quality improvement with facility-led active case finding (QI-ACF) was implemented in 10 districts of Northern Uganda with the highest TB burden to improve case notification among populations at highest risk of TB. Methods Using QI-ACF intervention approach in 48 facilities, we; 1) targeted key vulnerable populations, 2) engaged district and facility teams in TB systems strengthening, 3) conducted systematic screening and diagnosis in vulnerable groups (people living with HIV, fishing communities, and prisoners), and 4) trained health workers on national x-ray diagnosis guidelines for smear-negative patients. Facility-led QI-ACF meant that health care providers identified the target population, mobilized and massively screened suspects, and addressed gaps in documentation. Chest X-ray diagnosis was promoted for smear-negative TB among those suspects whose sputum examination was negative. The effect of the intervention on case notification was then assessed separately over the post intervention period. Results Over all TB case notification in the intervention districts increased from 171 to 223 per 100,000 population between the baseline months of October–December 2016 and end line month of April–June 2017. TB patient contacts had the majority of TB positive cases identified during active case finding (40, 6.1%). Fishing communities had the highest TB positivity rate at 6.8%. Prisoners accounted for the lowest number of TB positive cases at 34 (2.3%). Conclusion Targeting should be applied at all levels of TB intervention to improve yield: targeting districts and facilities with the lowest rates of case notification and targeting index patient contacts, HIV clients, and fishing communities. Screening tools are useful to guide health workers to identify presumptive cases. Efforts to improve availability of x-ray for TB diagnosis contributed to almost half of the new cases identified. Having all HIV patients who were eligible for viral load provide sputum for TB screening proved easy to implement. |
| first_indexed | 2024-12-11T05:28:55Z |
| format | Article |
| id | doaj.art-9fcf16bb30424a3b9e703a0897f97ab9 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-11T05:28:55Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-9fcf16bb30424a3b9e703a0897f97ab92022-12-22T01:19:30ZengBMCBMC Health Services Research1472-69632018-12-0118111210.1186/s12913-018-3786-2Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding interventionEsther Karamagi0Simon Sensalire1Martin Muhire2Herbert Kisamba3John Byabagambi4Mirwais Rahimzai5Frank Mugabe6Upenytho George7Jacqueline Calnan8Dejene Seyoum9Estella Birabwa10University Research Co., LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAIDUniversity Research Co., LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAIDUniversity Research Co., LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAIDUniversity Research Co., LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAIDUniversity Research Co., LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAIDUniversity Research Co., LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAIDMinistry of HealthMinistry of HealthUnited States Agency for International Development (USAID)United States Agency for International Development (USAID)United States Agency for International Development (USAID)Abstract Background Strategies to identify and treat undiagnosed prevalent cases that have not sought diagnostic services on their own, are necessary to treat TB in patients earlier and interrupt transmission. Late presentation for medical services of symptomatic patients require special efforts to detect early and notify TB in high risk populations. An intervention that combined quality improvement with facility-led active case finding (QI-ACF) was implemented in 10 districts of Northern Uganda with the highest TB burden to improve case notification among populations at highest risk of TB. Methods Using QI-ACF intervention approach in 48 facilities, we; 1) targeted key vulnerable populations, 2) engaged district and facility teams in TB systems strengthening, 3) conducted systematic screening and diagnosis in vulnerable groups (people living with HIV, fishing communities, and prisoners), and 4) trained health workers on national x-ray diagnosis guidelines for smear-negative patients. Facility-led QI-ACF meant that health care providers identified the target population, mobilized and massively screened suspects, and addressed gaps in documentation. Chest X-ray diagnosis was promoted for smear-negative TB among those suspects whose sputum examination was negative. The effect of the intervention on case notification was then assessed separately over the post intervention period. Results Over all TB case notification in the intervention districts increased from 171 to 223 per 100,000 population between the baseline months of October–December 2016 and end line month of April–June 2017. TB patient contacts had the majority of TB positive cases identified during active case finding (40, 6.1%). Fishing communities had the highest TB positivity rate at 6.8%. Prisoners accounted for the lowest number of TB positive cases at 34 (2.3%). Conclusion Targeting should be applied at all levels of TB intervention to improve yield: targeting districts and facilities with the lowest rates of case notification and targeting index patient contacts, HIV clients, and fishing communities. Screening tools are useful to guide health workers to identify presumptive cases. Efforts to improve availability of x-ray for TB diagnosis contributed to almost half of the new cases identified. Having all HIV patients who were eligible for viral load provide sputum for TB screening proved easy to implement.http://link.springer.com/article/10.1186/s12913-018-3786-2TuberculosisHigh risk populationScreeningActive case finding |
| spellingShingle | Esther Karamagi Simon Sensalire Martin Muhire Herbert Kisamba John Byabagambi Mirwais Rahimzai Frank Mugabe Upenytho George Jacqueline Calnan Dejene Seyoum Estella Birabwa Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention BMC Health Services Research Tuberculosis High risk population Screening Active case finding |
| title | Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention |
| title_full | Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention |
| title_fullStr | Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention |
| title_full_unstemmed | Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention |
| title_short | Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention |
| title_sort | improving tb case notification in northern uganda evidence of a quality improvement guided active case finding intervention |
| topic | Tuberculosis High risk population Screening Active case finding |
| url | http://link.springer.com/article/10.1186/s12913-018-3786-2 |
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