Amref Health Africa in Kenya, Global Fund TB project, Nairobi, Kenya.
BMC Public Health. 2020 Jul 29;20(1):1184. doi: 10.1186/s12889-020-09271-7.
Contact investigation is important in finding contacts of people who have Tuberculosis (TB) disease so that they can be given treatment and stop further transmission. The main objective of this study was to assess the contribution of community health volunteers (CHVs) to the number of TB patients notified to the National program in Kenya through household contact screening and referral of persons with TB signs and symptoms to the facilities for further investigation.
This was a retrospective desk review of project reports submitted to Amref Health Africa in Kenya by the sub-recipients implementing activities in the 33 counties with Case Notification Rate (CNR) of less 175/100,000 and Treatment Success Rate (TRS) of less than 88% as per the National strategic plan 2015-2018. Data for this study covered a period between January and December 2016. Data on the notified TB patients was obtained from the National Tuberculosis Information Basic Unit (TIBU). The study population included all the TB index cases whose households were visited by CHVs for contact screening. Data was recorded into excel spreadsheets where the descriptive analysis was done, proportions calculated and summarized in a table.
Community health volunteers visited a total of 26,307 TB patients (index cases) in their households for contact screening. A total of 44,617 household members were screened for TB with 43,012 (96.40%) from households of bacteriologically confirmed TB patients and 1606 (3.60%) from households of children under 5 years. The proportion of the persons referred to the number screened was 19.6% for those over 5 years and 21.9% from under 5 years with almost the same percentages for males and females at 19.2% and 19.7% respectively. The percentage of (TB) cases identified through tracing of contacts in these counties improved to 10% (5456) of the 54,913 cases notified to the National TB Program.
This study showed that in the 33 counties of Global Fund TB project implementation, the percentage of TB cases identified through tracing of contacts improved from 6 to 10% while the percentage of notified TB cases; all forms contributed through community referrals improved from 4 to 8%. Community health volunteers can play an effective role in household contact screening and referrals for the identification of TB.
接触者调查对于发现结核病（TB）患者的接触者非常重要，以便对他们进行治疗并阻止进一步传播。本研究的主要目的是评估社区卫生志愿者（CHV）通过家庭接触筛查发现国家规划中报告的结核病例数的贡献，并将有结核病症状和体征的人转诊到医疗机构进行进一步调查。
这是对肯尼亚 Amref Health Africa 收到的项目报告的回顾性桌面审查，这些报告是由在病例报告率（CNR）低于 175/100000 和治疗成功率（TRS）低于 88%的 33 个县的次级接受者实施活动的，根据国家战略计划 2015-2018。本研究的数据覆盖了 2016 年 1 月至 12 月期间。从国家结核信息基础单元（TIBU）获得通知的结核病例数据。研究人群包括所有家庭被 CHV 进行接触筛查的结核指数病例。数据记录在电子表格中，进行描述性分析，计算比例并总结在一个表中。
社区卫生志愿者共对 26307 例（索引病例）结核病患者的家庭进行了接触筛查。共筛查了 44617 名家庭成员的结核病，其中 43012 名（96.40%）来自细菌学确诊结核病患者的家庭，1606 名（3.60%）来自 5 岁以下儿童的家庭。被转诊到筛查人数的比例为 5 岁以上者为 19.6%，5 岁以下者为 21.9%，男女比例分别为 19.2%和 19.7%。在这些县，通过追踪接触者发现的病例比例提高到国家结核病规划报告的 54913 例的 10%（5456 例）。
本研究表明，在实施全球基金结核病项目的 33 个县，通过追踪接触者发现的结核病病例比例从 6%提高到 10%，而通过社区转诊报告的所有形式的结核病病例比例从 4%提高到 8%。社区卫生志愿者可以在家庭接触筛查和转诊中发挥有效作用，以发现结核病。
