title: The FIDELIS initiative: innovative strategies for increased case finding.
abstract: METHODS
  Low-income, high tuberculosis (TB) burden countries.
  
  
  OBJECTIVE
  To compare case finding of new smear-positive pulmonary TB patients in projects funded to apply innovative approaches.
  
  
  METHODS
  Prospective application of innovative approaches to case finding within routine services to determine the numbers of additional cases detected and the cost per additional case detected, according to the type of approach applied.
  
  
  RESULTS
  Between 2003 and 2007, 51 FIDELIS projects were implemented in 18 countries; 273,239 cases were reported, of which 85,267 were additional to the number reported in the previous year. The median cost per additional case was US$103. The interventions employed were: 1) social mobilisation and information, education and communication; 2) engagement of the private sector; 3) innovative approaches for microscopy services; 4) enhanced or semi-active case finding; 5) health systems strengthening; and 6) use of incentives. None of these was significantly more likely to detect additional cases or to have a lower cost per additional case than any of the others.
  
  
  CONCLUSIONS
  While there was a substantial increase in cases detected, at a moderate cost per additional case, we were unable to show that any single intervention had an advantage over the others.
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France. sven.hinderaker@cih.uib.no
authors.forename: S G
authors.initials: SG
authors.lastname: Hinderaker
authors.forename: I D
authors.initials: ID
authors.lastname: Rusen
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chiang
authors.forename: L
authors.initials: L
authors.lastname: Yan
authors.forename: E
authors.initials: E
authors.lastname: Heldal
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques / Q000191:economics; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D023801:Directly Observed Therapy; D042241:Early Diagnosis; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007391:International Cooperation; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents