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Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges

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Tuberculosis Health Action Learning Initiative (THALI), Kolkata, West Bengal 700107, India
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International Union against Tuberculosis and Lung Diseases, 75006 Paris, France
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The Union South East Asia Office, New Delhi 110016, India
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Department of Community Medicine, College of Medicine & JNM Hospital, Kalyani, West Bengal 741235, India
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Department of Community Medicine, College of Medicine & Sagore Dutta Hospital, Kamarhati, Kolkata 700058, India
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District Tuberculosis Officer, Government of Karnataka, Udupi 576104, India
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State Tuberculosis Officer, Govt of West Bengal, West Bengal 700091, India
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General Secretary, Indian Public Health Association (IPHA), HQ, Kolkata 700073, India
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Department of Community Medicine, ESIC Medical College and PGIMSR, Bengaluru 560010, India
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Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2019, 4(4), 134; https://doi.org/10.3390/tropicalmed4040134
Received: 10 September 2019 / Revised: 8 October 2019 / Accepted: 9 October 2019 / Published: 1 November 2019
Active case finding (ACF) for tuberculosis (TB) was implemented in 60 selected high TB burden wards of Kolkata, India. Community volunteers called TOUCH (Targeted Outreach for Upliftment of Community Health) agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the “care cascade” of PTBPs that were identified during July to December 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. An explanatory mixed-methods study with a quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Of the 3,86242 individuals that were enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited a referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%). The number needed to screen for one TB patient was 2183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage losses for attending health facilities, and substance abuse among PTBPs. The yield of ACF was suboptimal with low PTBP identification rate and a high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield. View Full-Text
Keywords: active case findings; Tuberculosis; TOUCH Agent; high TB burden area; TB surveillance; 4S Screening; THALI Project; SORT IT; operational research active case findings; Tuberculosis; TOUCH Agent; high TB burden area; TB surveillance; 4S Screening; THALI Project; SORT IT; operational research
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Dey, A.; Thekkur, P.; Ghosh, A.; Dasgupta, T.; Bandopadhyay, S.; Lahiri, A.; Sanju S V, C.; Dinda, M.K.; Sharma, V.; Dimari, N.; Chatterjee, D.; Roy, I.; Choudhury, A.; Shanmugam, P.; Saha, B.K.; Ghosh, S.; Nagaraja, S.B. Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed Methods Study on Outcomes and Implementation Challenges. Trop. Med. Infect. Dis. 2019, 4, 134.

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