Evaluation of active tuberculosis case finding through symptom screening and sputum microscopy of close contacts in Shandong, China

Abstract

Objectives: To evaluate the effect of active case finding through symptom screening and sputum microscopy of close contacts in a Fidelis (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) project.

Methods: Secondary data from all 35 counties were collected during implementation and used. They comprised new cases identified, number of close contacts screened and their relationships. Fifty-four in-depth interviews were conducted with staff from key stakeholders.

Results: A total of 13 310 symptomatic contacts of 5255 index cases were screened, and 90 new smear-positive cases were detected with a yield rate of 0.7%. The yield rate of close contacts was positively associated with smear grades of the index cases (P<0.01). Close contacts of cases, such as classmates and workmates, who lived in a closed contained setting, had a higher yield rate than family members (P<0.001). Gaps in project implementation such as training, incentives and sputum collection were identified through in-depth interviews.

Conclusions: The yield rate of close-contact screening of 0.7% was similar to other findings in China. There was a higher yield from screening of close contacts in congregated settings like schools and workshops. Future active case finding projects should provide clear operational guidelines and adequate training.