Ministry of Health, Kampala, Uganda.
Makerere University School of Public Health, Kampala, Uganda.
PLoS One. 2020 Jun 8;15(6):e0234418. doi: 10.1371/journal.pone.0234418. eCollection 2020.
Resource constraints in Low and Middle-Income Countries (LMICs) limit tuberculosis (TB) contact investigation despite evidence its benefits could outweigh costs, with increased efficiency when compared with intensified case finding (ICF). However, there is limited data on yield and cost per TB case identified. We compared yield and cost per TB case identified for ICF and Tuberculosis-Contact Investigation (TB-CI) in Uganda.
A retrospective cohort study based on data from 12 Ugandan hospitals was done between April and September 2017. Two methods of TB case finding (i.e. ICF and TB-CI) were compared. Regarding ICF, patients either self-reported their signs and symptoms or were prompted by health care workers, while TB-CI was done by home-visiting and screening contacts of TB patients. Patients who were presumed to have tuberculosis were requested to produce a sample for examination. TB yield was defined as a ratio of diagnoses to tests, and this was computed per method of diagnosis. The cost per TB case identified (medical, personnel, transportation and training) for each diagnosis method were computed using the activity-based approach, from the health care perspective. Cost data were analyzed using Windows Excel.
454 index TB cases and 2,707 of their household contacts were investigated. Thirty-one per cent of contacts (840/2707) were found to be presumptive TB cases. A total of 7,685 tests were done, 6,967 for ICF and 718 for TB-CI. The yields were 18.62% (1297/6967) and 5.29% (38/718) for ICF and TB-CI, respectively. It cost US$ 120.60 to diagnose a case of TB using ICF compared to US$ 877.57 for TB-CI.
The yield of TB-CI was found to be four-times lower and seven-times costlier compared to ICF. These findings suggest that ICF can improve TB case detection at a low cost, particularly in high TB prevalent settings.
资源有限限制了低收入和中等收入国家（LMICs）开展结核接触者调查，尽管有证据表明其效益可能超过成本，与强化病例发现（ICF）相比效率更高。然而，关于发现的结核病例数量和成本的数据有限。我们比较了乌干达 ICF 和结核接触者调查（TB-CI）的发现病例数量和成本。
2017 年 4 月至 9 月期间，基于 12 家乌干达医院的数据进行了一项回顾性队列研究。比较了两种结核病例发现方法（即 ICF 和 TB-CI）。关于 ICF，患者要么自行报告症状，要么由医务人员提示，而 TB-CI 通过家访和筛查结核患者的接触者进行。疑似患有结核病的患者被要求提供样本进行检查。结核发病率定义为诊断与检查的比例，根据每种诊断方法进行计算。使用基于活动的方法从医疗保健角度计算了每种诊断方法（医疗、人员、交通和培训）确定的每个结核病例的成本。使用 Windows Excel 分析成本数据。
共调查了 454 例索引结核病例和 2707 名其家庭接触者。31%的接触者（840/2707）被发现疑似结核病例。共进行了 7685 次检测，6967 次用于 ICF，718 次用于 TB-CI。ICF 和 TB-CI 的检出率分别为 18.62%（1297/6967）和 5.29%（38/718）。与 TB-CI 相比，使用 ICF 诊断一例结核的成本为 120.60 美元，而 TB-CI 的成本为 777.57 美元。
与 ICF 相比，TB-CI 的结核检出率低四倍，成本高七倍。这些发现表明，ICF 可以以较低的成本提高结核病例的检出率，特别是在结核高发地区。
