Of those who fall sick with TB, the vast majority are the poorest members of our societies who frequently have limited access to healthcare and no resources to deal with the condition. Some 60 % of the 10 million global TB cases each year are in Asia. The best way to control TB as with every contagious disease, is to combine vaccination with the tracing of people infected and treating each case to reduce transmission. To work out how this can be done most effectively, the IMPACT TB project, supported by the EU, worked with communities in Nepal and Vietnam. “Active case finding (ACF), and diagnostic networks are the keystones of controlling any infectious disease epidemic, and the GeneXpert machine network we have installed for IMPACT TB can be used for coronavirus surveillance in the community too,” explains Maxine Caws, the IMPACT TB Principal Investigator. The project found and treated over 2 000 cases of TB. “We have two proven active TB case finding and comprehensive patient care models in Vietnam and Nepal. Through the IMPACT TB project, we wanted to scale up these strategies and gather data for an evidence-based framework to apply them nationally,” says Caws. Nepal and Vietnam were chosen for IMPACT TB implementation because the Birat Nepal Medical Trust and the Friends of International TB Relief in Vietnam, have extensive experience and proven track records of successfully implementing ACF for TB in the community. The two countries both have very high burdens of TB and represent both low (Nepal) and middle (Vietnam) income countries in Asia.
Providing evidence to show tracing is worth the investment
“To make the case for investing in ACF for TB, we need to show evidence that the money invested has a strong impact on the disease. Governments need to know how much it costs to scale it up and which resources and infrastructure are needed to apply it effectively,” explains Caws. The project generated and analysed data to develop policy briefs with consortium partner the Karolinska Institute to help national TB programmes adopt realistic and optimised case finding strategies.
Practical steps to enable active case finding
Nepal’s National Strategic Plan aims to increase case notifications by 20 000 additional cases by 2025. “Our work showed clear pathways towards that goal,” says Caws. The project showed how ACF can reduce the financial burden of the illness on TB patients and their families, and how health services can optimise the strategy to reduce costs for the government. It highlighted which population groups should be focused on, to optimise the strategy, and demonstrated the value of advanced GeneXpert testing in community-based health centres. “We also underlined the need to create synergies between National TB Programmes, The Global Fund community groups and government health services in each district,” says Caws. In Vietnam the project showed chest X-ray screening finds a lot of people with TB who do not show classic symptoms like coughing. So one of the recommendations of the project is to optimise the existing X-ray services by offering invitations for subsidised or free screening and extending opening hours, to increase screening among those at risk. The project has already resulted in expansion of ACF within National TB Programmes, and the evidence from IMPACT TB will contribute to the revision of the World Health Organization guidelines in 2020.
IMPACT TB, Nepal, Vietnam, Active Case Finding, screening, tuberculosis