A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe.
Machekera, SM;
Wilkinson, E;
Hinderaker, SG;
Mabhala, M;
Zishiri, C;
Ncube, RT;
Timire, C;
Takarinda, KC;
Sengai, T;
Sandy, C;
(2019)
A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe.
PUBLIC HEALTH ACTION, 9 (2).
pp. 63-68.
ISSN 2220-8372
DOI: https://doi.org/10.5588/pha.18.0098
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SETTING: Ten districts and three cities in Zimbabwe. OBJECTIVE: To compare the yield and relative cost of identifying a case of tuberculosis (TB) using the three WHO-recommended algorithms (WHO2b, symptom inquiry only; WHO2d, chest X-ray [CXR] after a positive symptom inquiry; WHO3b, CXR only) and the Zimbabwe active case finding (ZimACF) algorithm (symptom inquiry plus CXR) to everyone. DESIGN: Cross-sectional study using data from the ZimACF project. RESULTS: A total of 38 574 people were screened from April to December 2017; 488 (1.3%) were diagnosed with TB using the ZimACF algorithm. Fewer TB cases would have been diagnosed with the WHO-recommended algorithms. This ranged from 7% fewer (34 cases) with WHO3b, 18% fewer (88 cases) with WHO2b and 25% fewer (122 cases) with WHO2d. The need for CXR ranged from 36% (WHO2d) to 100% (WHO3b). The need for bacteriological confirmation ranged from 7% (WHO2d) to 40% (ZimACF). The relative cost per case of TB diagnosed ranged from US$180 with WHO3b to US$565 for the ZimACF algorithm. CONCLUSION: The ZimACF algorithm had the highest case yield, but at a much higher cost per case than the WHO algorithms. It is possible to switch to algorithm WHO3b, but the trade-off between cost and yield needs to be reviewed by the Zimbabwean National TB Programme.
