title: An intervention of active TB case finding among smokers attending routine primary care facilities in China: an exploratory study.
abstract: BACKGROUND
  Smoking is an important risk factor of TB. However, no studies have been conducted to identify TB cases from smokers. We assessed the process and initial impact of active case finding among smokers at primary care facilities in a setting with high smoking rates and TB burden.
  
  
  METHODS
  A prospective quasi-experimental study was conducted in para-urban communities in Yunnan China between September 2013 and June 2014. Smokers attending primary care facilities in the intervention group were prescribed chest X-rays if they had diabetes or TB symptoms, or were elders or close contacts of TB patients. Those with X-rays suggestive of TB were referred to TB dispensaries for diagnosis. Passive case finding was practiced in the control group.
  
  
  RESULTS
  In the intervention group, we screened 471 smokers with high risks of TB, of whom 73% took chest X-ray examinations. Eight TB cases were diagnosed, reflecting a 1.7% yield rate of all screened smokers. Smokers with diabetes (OR 6.003, 95% CI 1.057-34.075) were more likely to have TB compared with those without. In total, the intervention group reported significantly higher TB notification rate compared with the control group (38.6 vs 22.9 per 100 000, p=0.016).
  
  
  CONCLUSIONS
  Active case finding among smokers with high risks of TB was feasible and contributed to improved notification rates.
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.affiliation: COMDIS Health Services Delivery Research Consortium, China Programme, University of Leeds, Shenzhen, China.
authors.forename: Guangyan
authors.initials: G
authors.lastname: Zou
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Marc Kc
authors.initials: MK
authors.lastname: Chong
authors.affiliation: Institute of Yunnan Tuberculosis Control, Yunnan Center for Disease Control and Prevention, Kunming, China xulinth@hotmail.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012907:Smoking / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology*
keywords: Active case finding; China; Primary care; Tobacco smoking; Tuberculosis