Comprehensive Approach to Tuberculosis Case Detection: Experience from an Urban Slum, Mumbai, Maharashtra, India

ABSTRACT

Background: Passive case finding leaves a number of tuberculosis (TB) cases unidentified which leads to increased transmission, morbidity, and mortality. Different approaches for case detection are needed to meet the End TB Strategy targets. Materials and methods: Between August 2014 and March 2016, a non-governmental organization (NGO) screened the population in two high burden areas of Mumbai through door-to-door survey, involving private practitioners, engaging community and contact surveys to identify cases early and initiate treatment for TB through a comprehensive approach to active case finding (ACF) in a community. A retrospective analysis of the data collected from this intervention was done. Results: Of 6230 symptomatic (3% of population), 3836 (61.5%) undertook tests, 652 (17%) were diagnosed with TB, and 591 (90.6%) were started on treatment. Through door-to-door survey, private practitioners, contact examination, and community engagement, 59%, 26%, 6.4%, and 8.6% cases were identified. Of these, 64% were females and 29% were of extra-pulmonary TB. Of 581 cases, 444 (76.4%) were successfully treated; 14 (2.4%) died; 7 (1.2%) failed treatment; 46 (7.9%) were drug-resistant TB; 33 (5.6%) lost to follow-up; and 37 (6.1%) were transferred out. Numbers needed to screen are 365, 11, and 20 of community, symptomatic, and household contacts, respectively. Conclusion: A comprehensive approach to active case finding identifies cases early, is feasible, and could be an effective complementary TB case detection strategy.