A role for community-level socioeconomic indicators in targeting tuberculosis screening interventions

Abstract

Tuberculosis screening programs commonly target areas with high case notification rates. However, this may exacerbate disparities by excluding areas that already face barriers to accessing diagnostic services. We compared historic case notification rates, demographic, and socioeconomic indicators as predictors of neighborhood-level tuberculosis screening yield during a mobile screening program in 74 neighborhoods in Lima, Peru. We used logistic regression and Classification and Regression Tree (CART) analysis to identify predictors of screening yield. During February 7, 2019-February 6, 2020, the program screened 29,619 people and diagnosed 147 tuberculosis cases. Historic case notification rate was not associated with screening yield in any analysis. In regression analysis, screening yield decreased as the percent of vehicle ownership increased (odds ratio [OR]: 0.76 per 10% increase in vehicle ownership; 95% confidence interval [CI]: 0.58-0.99). CART analysis identified the percent of blender ownership (≤ 83.1% vs > 83.1%; OR: 1.7; 95% CI: 1.2-2.6) and the percent of TB patients with a prior tuberculosis episode (> 10.6% vs ≤ 10.6%; OR: 3.6; 95% CI: 1.0-12.7) as optimal predictors of screening yield. Overall, socioeconomic indicators were better predictors of tuberculosis screening yield than historic case notification rates. Considering community-level socioeconomic characteristics could help identify high-yield locations for screening interventions.

Figure 1

Tuberculosis screening yield by neighborhood. Map was created by MBB using ArcMap Desktop version 10.8 (Environmental Systems Research Institute, Redlands, California, USA; https://www.esri.com/en-us/arcgis/products/arcgis-desktop/).

Figure 2

Distribution of tuberculosis screening yield according to neighborhood risk category (Approach 2a, n = 73 neighborhoods). Map was created by MBB using ArcMap Desktop version 10.8 (Environmental Systems Research Institute, Redlands, California, USA; https://www.esri.com/en-us/arcgis/products/arcgis-desktop/).

Figure 3

Distribution of tuberculosis screening yield according to neighborhood risk category (Approach 2b, n = 73 neighborhoods). Map was created by MBB using ArcMap Desktop version 10.8 (Environmental Systems Research Institute, Redlands, California, USA; https://www.esri.com/en-us/arcgis/products/arcgis-desktop/).