title: Feasibility, yield, and cost of active tuberculosis case finding linked to a mobile HIV service in Cape Town, South Africa: a cross-sectional study.
abstract: BACKGROUND
  The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This process is complicated by significant gaps in knowledge regarding mass screening. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing service.
  
  
  RESULTS
  The study was conducted at a mobile HIV testing service operating in deprived communities in Cape Town, South Africa. All HIV-negative individuals with symptoms suggestive of tuberculosis, and all HIV-positive individuals regardless of symptoms were eligible for participation and referred for sputum induction. Samples were examined by microscopy and culture. Active tuberculosis case finding was conducted on 181 days at 58 different sites. Of the 6,309 adults who accessed the mobile clinic, 1,385 were eligible and 1,130 (81.6%) were enrolled. The prevalence of smear-positive tuberculosis was 2.2% (95% CI 1.1-4.0), 3.3% (95% CI 1.4-6.4), and 0.4% (95% CI 1.4 015-6.4) in HIV-negative individuals, individuals newly diagnosed with HIV, and known HIV, respectively. The corresponding prevalence of culture-positive tuberculosis was 5.3% (95% CI 3.5-7.7), 7.4% (95% CI 4.5-11.5), 4.3% (95% CI 2.3-7.4), respectively. Of the 56 new tuberculosis cases detected, 42 started tuberculosis treatment and 34 (81.0%) completed treatment. The cost of the intervention was US$1,117 per tuberculosis case detected and US$2,458 per tuberculosis case cured. The generalisability of the study is limited to similar settings with comparable levels of deprivation and TB and HIV prevalence.
  
  
  CONCLUSIONS
  Mobile active tuberculosis case finding in deprived populations with a high burden of HIV and tuberculosis is feasible, has a high uptake, yield, and treatment success. Further work is now required to examine cost-effectiveness and affordability and whether and how the same results may be achieved at scale.
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom. katharina.kranzer@lshtm.ac.uk
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
authors.forename: Gesine
authors.initials: G
authors.lastname: Meyer-Rath
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
authors.forename: Eudoxia
authors.initials: E
authors.lastname: Raditlhalo
authors.forename: Darshini
authors.initials: D
authors.lastname: Govindasamy
authors.forename: Nienke
authors.initials: N
authors.lastname: van Schaik
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
mesh_terms: D000328:Adult; D016358:Contact Tracing; D003430:Cross-Sectional Studies; D003710:Demography; D005240:Feasibility Studies; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008952:Mobile Health Units / Q000191:economics* / Q000706:statistics & numerical data; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology