title: Yield of intensified tuberculosis case-finding activities using Xpert(®) MTB/RIF among risk groups in Nepal.
abstract: METHODS
  Twenty-two districts of Nepal, where intensified case-finding (ICF) activities for tuberculosis (TB) were implemented among risk groups under the TB REACH initiative in collaboration with the National TB Programme from July 2013 to November 2015.
  
  
  OBJECTIVE
  To assess the yield of TB screening using an algorithm with smear microscopy followed by Xpert(®) MTB/RIF.
  
  
  METHODS
  A descriptive study using routinely collected data.
  
  
  RESULTS
  Of 145 679 individuals screened, 28 574 (19.6%) had presumptive TB; 1239 (4.3%) of these were diagnosed with TB and 1195 (96%) were initiated on anti-tuberculosis treatment. The yield of screening was highest among people living with the human immunodeficiency virus (PLHIV) (6.1%), followed by household contacts (3.5%) and urban slum dwellers (0.5%). Among other risk groups, such as prisoners, factory workers, refugees and individuals with diabetes, the yield was less than 0.5%. The number needed to screen to diagnose an active TB case was 17 for PLHIV, 29 for household contacts and 197 for urban slum dwellers. Of 11 525 patients from ICF and the routine programme, 112 (1%) were diagnosed with multidrug-resistant TB.
  
  
  CONCLUSIONS
  There was a substantial yield of TB cases among risk groups such as PLHIV and household contacts. Although the yield in urban slum dwellers was found to be moderate, some intervention should nonetheless be targeted because of the large population and poor access to care in this group.
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Khanal
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Baral
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: P
authors.initials: P
authors.lastname: Shrestha
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Puri
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Kandel
authors.affiliation: National Tuberculosis Centre, Thimi, Bhaktapur, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Lamichanne
authors.affiliation: Nuffield Centre for International Health and Development, Leeds Institute of Health Science, Leeds, UK.
authors.forename: H
authors.initials: H
authors.lastname: Elsey
authors.affiliation: PHTB Consult, Tilburg, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Brouwer
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Goel
authors.affiliation: Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: P
authors.initials: P
authors.lastname: Chinnakali
keywords: TB REACH; number needed to screen; operational research; systematic screening