Increasing tuberculosis case detection through intensive referral and tracing in Hunan, China.
OBJECTIVE
To explore a feasible approach to increase case finding of tuberculosis (TB) through intensive referral and tracing of TB suspects and patients.


METHODS
A quasi-experimental study was conducted in three Chinese cities. A strategic referral and tracing system was developed for the local situation in Hunan, China. Data from a 1-year monitoring of referral, tracing and diagnosis of TB suspects/cases were used to assess outcomes.


RESULTS
Among 126 public general hospitals and clinics in 38 project counties, the 124 (98.4%) health facilities that participated referred an average of 10 TB suspects and cases to the TB dispensary every month. A total of 6364 suspects and 5759 cases were referred. Compared to the previous year, the number of TB suspects increased by 102.1%, from 25 719 to 51 967; the referral of TB suspects increased five-fold; 10 596 new smear-positive pulmonary tuberculosis (PTB) cases were identified; and the notification of new smear-positive PTB increased by 112.9%, from 27.1/100 000 before the project year to 57.7/100 000, a significantly higher percentage than that of non-project areas, which had a notification rate of 38.8/100 000.


CONCLUSIONS
Intensive referral and tracing of TB suspects/patients is a feasible and effective method of increasing case finding. Strengthening administrative interventions and incentives is essential to achieve project objectives.
Bai
L Q
LQ
Department of Social Medicine, School of Public Health, Central South University, Changsha, China.
Yang
H L
HL
Jian
X W
XW
He
X G
XG
Chen
Y F
YF
Tang
Y
Y
Cheng
S M
SM
Xiao
S Y
SY
D002681:China; D016358:Contact Tracing / Q000379:methods*; D006293:Health Promotion; D006801:Humans; D007400:Interprofessional Relations; D012017:Referral and Consultation; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*