Intensified Tb Case Finding In Swaziland: Whom Do You Find In The Household In A High Tb/Hiv Burden Setting?

Objectives: Active Case Finding (ACF) strategies in communities increases TB and HIV case detection, yet the direct impact of these strategies on the TB and HIV epidemics remains unknown. Leveraging TB REACH funding, Baylor College of Medicine Children’s Foundation-Swaziland (BCMCF-SD) implemented a community-based ACF program to extend health interventions to a representative population of Swaziland. Methods: BCMCF-SD screened household contacts of index cases (ICs) initiating TB treatment in 7 health facilities. Contacts reported to have a positive TB screen were referred to a health facility for sputum submission. Home visits were conducted to reach contacts with presumptive TB who did not visit a health facility. We describe the population reached through household ACF from May 2013-December 2015, according to age, gender, reported HIV-status, and number of additional TB cases. Results: 3,342 ICs were linked to 876 households yielding 5,337 contacts. Of these contacts, 2,635 (49%) provided sputum for TB investigation, with 88% (2,324/2,635) of sputum specimens collected during a home visit. Our program identified 2% (45/2,635) additional bacteriologically confirmed TB cases. HIV-positivity was reported for 9% (464/5,336) of contacts while 55% (2,946/5,336) were reported to have an unknown HIV-status. Males and adolescents were more likely to report an HIV unknown status (p < 0.01). Conclusion: Although effective at finding additional TB cases, household-based ACF strategies may be limited in identifying bacteriologically confirmed cases among children, adolescents and elders in this setting. Our model of ACF provides an ideal opportunity to reduce the TB burden by extending services to hard-to-reach populations. Palavras-chave: busca de comunicantes, sorodiagnóstico da AIDS, Suazilandia, tuberculose.