Evaluation of a tuberculosis screening program for high-risk students in Toronto schools.
OBJECTIVE
To evaluate the effectiveness of a tuberculosis (TB) screening program for high-risk students in elementary and secondary schools.


METHODS
Cross-sectional study of the 1992-93 school screening program conducted by the Department of Public Health of the City of Toronto. Program costs were calculated with the use of 1993 wages, and costs for medical care were based on the 1993 fee schedule of the Ontario Medical Association.


METHODS
Elementary and secondary schools in the City of Toronto.


METHODS
Students enrolled for the first time in any grade who were born in a country where TB is endemic or who were aboriginal Canadians were eligible. Of 44,179 students in Toronto schools 1775 met the eligibility criteria.


METHODS
Students were administered a Mantoux skin test, and those with a significant reaction (an induration of 10 mm or more in diameter) were advised to consult a physician for follow-up.


METHODS
Participation rate, number of participants with a significant reaction, percentage of these who were prescribed isoniazid and who completed chemoprophylaxis, potential number of preventable cases and costs associated with preventing each case.


RESULTS
Of 1775 eligible students 42.9% (761) agreed to participate, and 40.6% (720) were screened. Significant skin-test reactions were detected in 22.5% (162/720) of the participants screened. Of these, 87.7% (142/162) saw a physician; subsequently, 2 cases of TB (1 active and 1 inactive) were detected. Of the remaining 140 students 44.3% (62) were prescribed isoniazid, of whom 9.7% (6/62) refused chemoprophylaxis. Of the remaining 56 students 82.1% (46) completed at least 6 months of chemoprophylaxis and 10.7% (6) were completing treatment at the end of the study. An estimated 3.2 cases were prevented, at a cost of $13,493.15 per case, whereas the undiscounted cost of treatment for an uncomplicated active case of TB in a patient under 19 years of age was $4503.82.


CONCLUSIONS
The effectiveness of this screening program was significantly reduced by poor participation and poor rates of prescription of isoniazid by physicians. Appropriate strategies are needed to reduce barriers to the implementation of these programs.
Yuan
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L
Department of Preventive Medicine and Biostatistics, University of Toronto, Ont.
Richardson
E
E
Kendall
P R
PR
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D009864:Ontario; D015397:Program Evaluation; D012307:Risk Factors; D012572:School Health Services / Q000458:organization & administration*; D014376:Tuberculosis / Q000191:economics / Q000517:prevention & control*; D014504:Urban Health
D000995:Antitubercular Agents