TB Reach project results show need for new approaches to lift case detection rates

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PLOS summary resullts tbFor a decade and a half after the World Health Organization launched the expansion of directly observed treatment for tuberculosis, strides against the disease, highlighted by a nearly six-fold increase in cases documented, looked promising, an article released Thursday on PLOS ONE notes. But over the last half decade, with efforts largely reliant on “passive case finding” — that is waiting for people sick with TB to turn up at health facilities seeking care — the numbers of cases detected and acted on leveled off, leaving three million cases undiagnosed or untreated.

The article, A Multi-Site Evaluation of Innovative Approaches to Increase Tuberculosis Case Notification: Summary Results details outcomes of 28 projects that sought to improve TB detection rates by taking active measures and responding to local realities. Across the projects, the rates of documented cases rose nearly 25 percent, the findings show. The 19 projects that compared results of interventions with control populations showed an increase in documented cases more than 10 times that among comparable populations without the added interventions. Most of the projects, which were funded through the Stop TB Partnership’s TB Reach, added more than one new approach. They included using community volunteers, mobile diagnostic teams, improved diagnostic tools that included digital X-rays and GeneXpert machines, and targeting populations of particularly high risk for TB infection, including miners, people living with HIV, prisoners, and rural and urban residents with health care access obstacles.

The gains yielded by those projects show what added funding and “fresh thinking” can accomplish, says a release from Stop TB Partnership announcing the results. Funding for the projects came from the Canadian International Development Agency.

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