Community Referral for Presumptive TB in Nigeria: A Comparison of Four Models of Active Case Finding
BACKGROUND:
Engagement
of communities and civil society organizations is a critical part of the
Post-2015 End TB Strategy. Since 2007, many models of community referral have
been implemented to boost TB case detection in Nigeria. Yet clear insights into
the comparative TB yield from particular approaches have been limited.
METHODS:
We
compared four models of active case finding in three Nigerian states. Data on
presumptive TB case referral by community workers (CWs), TB diagnoses among
referred clients, active case finding model characteristics, and CWs
compensation details for 2012 were obtained from implementers and CWs via
interviews and log book review. Self-reported performance data were triangulated
against routine surveillance data to assess concordance. Analysis focused on
assessing the predictors of presumptive TB referral.
RESULTS:
CWs
referred 4-22 % of presumptive TB clients tested, and 4-24 % of the
total TB cases detected. The annual median referral per CW ranged widely among
the models from 1 to 48 clients, with an overall average of 13.4 referrals per
CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr)
per CW (H =70.850, p < 0.001) was obtained by the model with training
supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model).
The model with irregularly supervised, trained, and compensated CWs contributed
the least to TB case detection with a median of 13 referrals per CW/yr and mean
of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB
referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to
explaining presumptive TB referral after controlling for other variables.
CONCLUSION:
All
community based TB case-finding projects studied referred a relative low number
of symptomatic individuals. The study shows that incentivized referral,
appropriate selection of CWs, supportive supervision, leveraged treatment
support roles, and a responsive TB program to receive clients for testing were
the key drivers of community TB case finding.
By: Adejumo AO1, Azuogu B2, Okorie O3, Lawal OM4, Onazi OJ5, Gidado M5, Daniel OJ6, Okeibunor JC7, Klinkenberg E8,9, Mitchell EM8,9.
- 1Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. drolus_adejumo@yahoo.com.
- 2Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria.
- 3Abia State TB and Leprosy Control Programme, Umuahia, Abia, Nigeria.
- 4Oyo State TB and Leprosy Control programme, Ibadan, Oyo, Nigeria.
- 5KNCV/ TB CARE I, Abuja, Nigeria.
- 6Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria.
- 7Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu, Nigeria.
- 8KNCV Tuberculosis Foundation, the Hague, The Netherlands.
- 9Department of Global Health, Academic Medical Center, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands.
- BMC Public Health. 2016 Feb 23;16(1):177. doi: 10.1186/s12889-016-2769-7.
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