Prediagnostic Loss to Follow-up in an Active Case Finding Tuberculosis Programme: a Mixed-methods Study from Rural Bihar, India

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 May 17

PMID 32414819

Citations 13

Authors

Tushar Garg

Vivek Gupta

Dyuti Sen

Madhur Verma

Miranda Brouwer

Rajeshwar Mishra

Manish Bhardwaj

Affiliations

Soon will be listed here.

Abstract

Objective: To quantify the prediagnostic loss to follow-up (PDLFU) in an active case finding tuberculosis (TB) programme and identify the barriers and enablers in undergoing diagnostic evaluation.

Design: Explanatory mixed-methods design.

Setting: A rural population of 1.02 million in the Samastipur district of Bihar, India.

Participants: Based on their knowledge of health status of families, community health workers or CHWs (called accredited social health activist or locally) and informal providers referred people to the programme. The field coordinators (FCs) in the programme screened the referrals for TB symptoms to identify presumptive TB cases. CHWs accompanied the presumptive TB patients to free diagnostic evaluation, and a transport allowance was given to the patients. Thereafter, CHWs initiated and supported the treatment of confirmed cases. We included 13 395 community referrals received between January and December 2018. To understand the reasons of the PDLFU, we conducted in-depth interviews with patients who were evaluated (n=3), patients who were not evaluated (n=4) and focus group discussions with the CHWs (n=2) and FCs (n=1).

Outcome Measures: Proportion and characteristics of PDLFU and association of demographic and symptom characteristics with diagnostic evaluation.

Results: A total of 11 146 presumptive TB cases were identified between January and December 2018, out of which 4912 (44.1%) underwent diagnostic evaluation. In addition to the free TB services in the public sector, the key enablers were CHW accompaniment and support. The major barriers identified were misinformation and stigma, deficient family and health provider support, transport challenges and poor services in the public health system.

Conclusion: Finding the missing cases will require patient-centric diagnostic services and urgent reform in the health system. A community-oriented intervention focusing on stigma, misinformation and patient support will be critical to its success.

Citing Articles

Bridging the "know-do" gap to improve active case finding for tuberculosis in India: A qualitative exploration into national tuberculosis elimination program staffs' perspectives.

Shewade H, Ravichandran P, Pradeep S, Kiruthika G, Shanmugasundaram D, Chadwick J PLoS One. 2024; 19(11):e0309750.

PMID: 39495760 PMC: 11534205. DOI: 10.1371/journal.pone.0309750.

Case fatality among people with drug-susceptible TB enrolled in a private health sector TB treatment support program in Bihar, India during the first year of the COVID-19 pandemic.

Faust L, Ranjan A, Jha N, Pai M, Huddart S PLOS Glob Public Health. 2024; 4(9):e0003277.

PMID: 39264895 PMC: 11392330. DOI: 10.1371/journal.pgph.0003277.

Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies.

Jhaveri T, Jhaveri D, Galivanche A, Lubeck-Schricker M, Voehler D, Chung M PLoS Med. 2024; 21(5):e1004409.

PMID: 38805509 PMC: 11166313. DOI: 10.1371/journal.pmed.1004409.

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.

Taylor M, Medley N, Van Wyk S, Oliver S Cochrane Database Syst Rev. 2024; 3:CD014756.

PMID: 38511668 PMC: 10955804. DOI: 10.1002/14651858.CD014756.pub2.

A systematic review and meta-analysis of active case finding for tuberculosis in India.

Garg T, Chaisson L, Naufal F, Shapiro A, Golub J Lancet Reg Health Southeast Asia. 2023; 7:100076.

PMID: 37383930 PMC: 10305973. DOI: 10.1016/j.lansea.2022.100076.

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