Improving TB case notification in northern Uganda: evidence of a quality improvement-guided active case finding intervention
Published in BMC Health Services Research, this paper describes a QI-based intervention with aresearch component used to document and explain changes in TB case notification in 10 districts in North-ern Uganda among high-risk populations. The intervention engaged district leaders and facility-level healthworkers in targeting, systematic screening and diagnosiswithin vulnerable groups and taking steps to improve ad-herence to guidelines for smear-negative patients. Targeting, a commonly used technique in public health, uses aspecialized health intervention approach for a specific group of people rather than the general population. Using QI-ACF intervention approach in 48 facilities, we; 1) targeted key vulnerable populations, 2) engaged district and facility teams in TB systems strengthening, 3) conducted systematic screening and diagnosis in vulnerable groups (people living with HIV, fishing communities, and prisoners), and 4) trained health workers on national x-ray diagnosis guidelines for smear-negative patients.Over all TB case notification in the intervention districts increased from 171 to 223 per 100,000 population between the baseline months of October–December 2016 and end line month of April–June 2017. TB patient contacts had the majority of TB positive cases identified during active case finding (40, 6.1%). Fishing communities had the highest TB positivity rate at 6.8%. Prisoners accounted for the lowest number of TB positive cases at 34 (2.3%). Targeting should be applied at all levels of TB intervention to improve yield: targeting districts and facilities with the lowest rates of case notification and targeting index patient contacts, HIV clients, and fishing communities. Screening tools are useful to guide health workers to identify presumptive cases. Efforts to improve availability of x-ray for TB diagnosis contributed to almost half of the new cases identified.