Improving TB control: efficiencies of case-finding interventions in Nigeria.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2023-09-21 DOI:10.5588/pha.23.0028

A P Babayi, B B Odume, C L Ogbudebe, O Chukwuogo, N Nwokoye, C C Dim, S Useni, D Nongo, R Eneogu, O Chijioke-Akaniro, C Anyaike

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Abstract

Setting: KNCV Nigeria implements seven key TB case-finding interventions. It was critical to evaluate the efficiency of these interventions in terms of TB yield to direct future prioritisation in the country.

Objectives: To compare the efficiency of active case-finding (ACF) interventions for TB in Nigeria.

Design: Data from the 2020-2022 implementing period were analysed retrospectively. Intervention efficiencies were analysed using the number needed to screen (NNS), the number needed to test (NNT) and the true screen-positive (TSP) rate.

Results: Across the interventions, 21,704,669 persons were screened for TB, 1,834,447 (8.5%) were presumed to have TB (7.7% pre-diagnostic drop-out rate) and 122,452 were diagnosed with TB (TSP rate of 7.2%). The average TSP rate of interventions that used both the WHO four-symptom screen (W4SS) and portable digital X-ray (PDX) screening algorithm was significantly higher (22.6%) than those that employed the former alone (7.0%; OR 3.9, 95% CI 3.74-3.98; P < 0.001). The average NNT for interventions with W4SS/PDX screening was 4 (range: 4-5), while that of W4SS-only screening was 14 (range: 11-22).

Conclusions: Interventions using the PDX in addition to W4SS for TB screening were more efficient in terms of TB case yield than interventions that used symptom-based TB screening only.

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改进结核病控制：尼日利亚病例发现干预措施的效率。

背景：KNCV尼日利亚实施了七项关键的结核病病例发现干预措施。从结核病产量的角度评估这些干预措施的效率，以指导该国未来的优先事项，这一点至关重要。目的：比较尼日利亚结核病主动病例发现（ACF）干预措施的效率。设计：对2020-2022年实施期间的数据进行了回顾性分析。使用需要筛查的数量（NNS）、需要检测的数量（NN）和真实筛查阳性率（TSP）分析干预效率。结果：在所有干预措施中，21704669人接受了结核病筛查，1834447（8.5%）被认为患有结核病（7.7%的诊断前脱落率），122452被诊断患有结核病（TSP率为7.2%）。使用世界卫生组织四症状筛查（W4SS）和便携式数字X射线（PDX）筛查算法的干预措施的平均TSP率（22.6%）显著高于单独使用前者的干预措施（7.0%；OR 3.9，95%CI 3.74-3.98；P<0.001）W4SS/PDX筛查干预的平均NNT为4（范围：4-5），而仅W4SS筛查干预的NNT为14（范围：11-22）。结论：在结核病病例发生率方面，使用PDX和W4SS进行结核病筛查的干预措施比仅使用基于症状的结核病筛查的介入措施更有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.