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. 2021 Apr 14;6(2):50.
doi: 10.3390/tropicalmed6020050.

Comparative Yield of Tuberculosis during Active Case Finding Using GeneXpert or Smear Microscopy for Diagnostic Testing in Nepal: A Cross-Sectional Study

Suman Chandra Gurung  1   2 , Kritika Dixit  1   3 , Bhola Rai  1 , Raghu Dhital  1 , Puskar Raj Paudel  1   4 , Shraddha Acharya  1 , Gangaram Budhathoki  1 , Deepak Malla  1 , Jens W Levy  4 , Knut Lönnroth  3 , Andrew Ramsay  5 , Buddha Basnyat  6 , Anil Thapa  7 , Gokul Mishra  1   2 , Bishal Subedi  8 , Mohammad Kashim Shah  9 , Anil Shrestha  9 , Maxine Caws  1   2
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Comparative Yield of Tuberculosis during Active Case Finding Using GeneXpert or Smear Microscopy for Diagnostic Testing in Nepal: A Cross-Sectional Study

Suman Chandra Gurung et al. Trop Med Infect Dis. .

Abstract

This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening of social contacts of known index cases, TB camps in remote areas, and screening for hospital out-patient department (OPD) attendees. Symptomatic individuals were then tested using smear microscopy or GeneXpert MTB/RIF as first diagnostic test. Yield rates were compared for each intervention and diagnostic method. We evaluated additional cases notified from ACF interventions by comparing case notifications of the intervention and control districts using standard TB REACH methodology. The project identified 1092 TB cases. The highest yield was obtained from OPD screening at hospitals (n = 566/1092; 52%). The proportion of positive tests using GeneXpert (5.5%, n = 859/15,637) was significantly higher than from microscopy testing 2% (n = 120/6309). (OR = 1.4; 95%CI = 1.12-1.72; p = 0.0026). The project achieved 29% additionality in case notifications in the intervention districts demonstrating that GeneXpert achieved substantially higher case-finding yields. Therefore, to increase national case notification for TB, Nepal should integrate OPD screening using GeneXpert testing in every district hospital and scale up of community-based ACF of TB patient contacts nationally.

Keywords: ACF interventions; ACF strategies; GeneXpert; Nepal; TB yield rate; active case finding.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart showing the screening to diagnosis and treatment process in the intervention district.
Figure 2
Figure 2
Comparison of case notification before and after implementation of active case finding (ACF) interventions (unadjusted data).
Figure 3
Figure 3
Comparison of case notifications before and after implementation of ACF interventions (3 year trend-adjusted, i.e., estimated case notification).
See this image and copyright information in PMC

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