Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs.
Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources. Methods. Mache Chache ("Go and Seek") was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance. Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities. Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.
Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA; Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA.
Guesly J
GJ
Delva
Institute of Human Virology, University of Maryland School of Medicine, 4, Delmas 81, Port-au-Prince, Haiti.
Ingrid
0000-0003-1532-6081
I
Francois
Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA; Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA.
Cassidy W
0000-0001-5059-7894
CW
Claassen
Institute of Human Virology, University of Maryland School of Medicine, 4, Delmas 81, Port-au-Prince, Haiti.
Darwin
0000-0002-5130-8641
D
Dorestan
Institute of Human Virology, University of Maryland School of Medicine, 4, Delmas 81, Port-au-Prince, Haiti.
Barbara
0000-0003-3446-894X
B
Bastien
Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA.
Sandra
0000-0003-2260-2718
S
Medina-Moreno
Institute of Human Virology, University of Maryland School of Medicine, 4, Delmas 81, Port-au-Prince, Haiti.
Dumesle St
DS
Fort
Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA; Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA.
Robert R
0000-0002-3371-6908
RR
Redfield
Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA; Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA.
Ulrike K
0000-0002-6671-0115
UK
Buchwald
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