NEJM study shows community-wide active case finding has the potential to End TB using existing tools

The paper, Community-wide Screening for Tuberculosis in a High-Prevalence Setting, published yesterday in the New England Journal of Medicine, showed that annual community-wide TB screening in a disease endemic area was more effective than standard passive case detection in reducing TB prevalence. The study shows that achieving the rate of decline necessary to reach ambitious End TB targets using existing tools is possible – if efforts are rapidly and adequately scaled up.

The study was undertaken by an extensive multi-organisational team, led by Professor Guy B Marks, The Union’s President-Elect. This randomised controlled trial – the first ever of this type of intervention – investigated the effects of screening for TB among all adult residents of a community, annually for three years. Results showed a nearly 50 percent reduction in the number of people with TB disease in the community and a 50 percent reduction in the number of children (aged 6 to 14 years) showing TB infection.

The rationale behind community-wide active case finding, or screening whole communities for TB, is to find and treat everyone with TB in a community and stop the spread of the disease. Such a method is not limited by waiting for people showing symptoms to seek care, nor by health system weakness, nor is it limited to the minority of cases who are in “high risk” groups. These limitations are present in existing global approaches to TB control: passive case detection (optimising diagnostic and treatment services for patients who seek care for symptoms of TB), and targeted active case finding (screening for TB in high risk groups only).

100,000 people participated in the study, which took place in a Mekong delta province in Viet Nam with a high burden of TB. Screening involved the collection of sputum from people in their homes and the testing of the specimen using a molecular test for TB. The study was done in collaboration with the National Tuberculosis Programme of Viet Nam, and funded by funded by the Australian National Health and Medical Research Council.