The IMPACT TB project successfully implemented active case finding over two years in 6 districts of Ho Chi Minh City, Vietnam and four districts of Nepal. Over 2,500 TB cases were diagnosed and enrolled to treatment by the project while significant contributions have also been made to both the local and global evidence base for active TB case finding implementation.
The project demonstrated that, in Vietnam, a middle income, high TB burden country both salaried and incentivised human resource models are effective for TB case finding and result in additional case detection (16% additionality in project districts in Ho Chi Minh City). The additionality in All Forms TB notifications disaggregated by human resource model in Vietnam was +8.8% [95% CI: +8.0%, +9.6%] from volunteer districts compared to +12.3% [95% CI: +11.4%, +13.2%] from salaried employee districts. These rates corresponded to 480 [95% CI: 439, 521] additional All Forms TB notifications in volunteer districts and 610 [95% CI: 565, 655] in salaried employee districts. Therefore, where resources allow, the salaried model should be implemented for scale-up to achieve maximum impact in increasing TB case notification. In Nepal, one of the world’s poorest countries, the project showed that active case finding using GeneXpert testing has substantially higher yields compared to traditional smear microscopy. The cost per case detected is however substantially higher at 513 USD per case detected using smear compared to 909 per case detected using GeneXpert.
The modeling work package has further shown that active case finding can make substantial contributions to the achievement of END-TB strategy goals in both Vietnam and Nepal, but that intensification of case finding alone is not sufficient to reduce the epidemic to less than 10 cases per 100,000 by 2035. To achieve this crucial target which has been adopted by the governments of both countries, TB prevention must be scaled up in concert with active case finding.
The results of IMPACT TB have been widely disseminated at both the national and international level and across trans-disciplinary fora. Internationally, consortium members have chaired symposia, participated in panels, given oral presentations and presented posters. Three manuscripts have been published in international peer reviewed open access journals with a further ten in draft. Policy dialogues were held in both Vietnam and Nepal in 2019 to disseminate research findings and engage a broad range of local and multilateral policymakers, as well as people affected by TB, community representatives and healthcare workers.
