Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs

Abstract

Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources. Methods. Mache Chache ("Go and Seek") was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance. Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities. Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.

Figure 1

Location of the basic management units of the target population (TP), evaluation population (EP), and control population (CP). (a) Map of Haiti: #1: Hôpital Saint-Boniface, Fond-des-Blanc (CP). (b) Map of Port-au-Prince (A) and surrounding area: #2: Canaan (TP/EP). #3: Hôpital de Fermathe (CP). (c) Map of greater Port-au-Prince (A): #4: Centre de Santé Lucelia Bontemps (EP). #5: Hôpital Foyer Saint Camille (TP/EP). #6: Centre Professionnel des Femmes Ouvrières (CPFO) (TP/EP). #7: CHAPI (CP). #8: Hôpital Bernard Mevs (EP). #9: Hôpital Universitaire de La Paix (EP). #10: Hôpital de la Communauté Haïtienne (TP/EP).

Figure 2

Composite sputum characteristics (saliva, mucous, and sanguineous) versus composite smear grades of 108 pulmonary TB patients at FSC. Composite sputum characteristic and sputum grade consist of the highest respective sputum characteristic or sputum score from available samples for one patient. SS−: smear-negative. The number above each column represents the number of patients in that category.