title: Increasing tuberculosis case detection through intensive referral and tracing in Hunan, China.
abstract: 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.
authors.affiliation: Department of Social Medicine, School of Public Health, Central South University, Changsha, China.
authors.forename: L Q
authors.initials: LQ
authors.lastname: Bai
authors.forename: H L
authors.initials: HL
authors.lastname: Yang
authors.forename: X W
authors.initials: XW
authors.lastname: Jian
authors.forename: X G
authors.initials: XG
authors.lastname: He
authors.forename: Y F
authors.initials: YF
authors.lastname: Chen
authors.forename: Y
authors.initials: Y
authors.lastname: Tang
authors.forename: S M
authors.initials: SM
authors.lastname: Cheng
authors.forename: S Y
authors.initials: SY
authors.lastname: Xiao
mesh_terms: D002681:China; D016358:Contact Tracing / Q000379:methods*; D006293:Health Promotion; D006801:Humans; D007400:Interprofessional Relations; D012017:Referral and Consultation; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*