Findings from a pilot project to assess the feasibility of active tuberculosis case finding among seniors in rural Sichuan Province, China, 2017

• Published in: PloS one Vol. 14; no. 3; p. e0214761
• Main Authors: Zhang, Canyou, Xia, Lan, Rainey, Jeanette J, Li, Yuan, Chen, Chuang, Rao, Zhengyuan, Duan, Jinchao, Sun, Hongying, Cao, Jie, Liu, Ping, Cheng, Jun, Zhang, Hui, Wu, Jianlin, Wang, Lixia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.03.2019; Public Library of Science (PLoS)
• Subjects: Acceptability; Aged; Aged, 80 and over; Aging; Alcoholic beverages; Bacilli; Biology and Life Sciences; Chest x-rays; China - epidemiology; Cough; Demographic aspects; Development and progression; Diabetes mellitus; Disease control; Disease prevention; Diseases and pests; Drinking (Alcoholic beverages); Elderly; Feasibility Studies; Female; Health aspects; Health care; Health risks; Hemoptysis; HIV; Human immunodeficiency virus; Humans; Laboratory tests; Male; Medical diagnosis; Medical personnel; Medical screening; Medicine and Health Sciences; Older people; People and Places; Pilot Projects; Project feasibility; Research and Analysis Methods; Risk analysis; Risk factors; Rural Population - statistics & numerical data; Signs and symptoms; Smear; Staff participation; Tuberculosis; Tuberculosis, Pulmonary - epidemiology; X-rays; Yield; China; United States; Beijing China; Vietnam; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0214761

China has a substantial tuberculosis (TB) disease burden and an aging population. Seniors have a higher risk of developing TB disease compared to younger age groups. Active case finding (ACF) could help identify seniors with TB disease. From March to June 2017, we included ACF during annual physical check-ups for persons aged ≥ 65 years in Bayi, Sichuan Province. Seniors with clinical TB symptoms (i.e., cough lasting ≥ 2 weeks and/or hemoptysis) or one or more risk factors (e.g., previous TB disease, diabetes, and heavy alcohol consumption) were offered chest x-rays. We used acid-Fast Bacilli smear and solid culture laboratory testing for TB confirmation. We calculated the yield (i.e., cases identified among seniors screened) and cost per new each TB case detected. Focus group-interviews were conducted with health care workers and seniors to evaluate project acceptability. Participation rates and acceptability were used to assess feasibility. Of the 2,393 seniors residing in Bayi, 2,049 (85.6%) were enrolled in the pilot project. Of these seniors, 794 (38.7%) presented with at least one TB risk factor and 74 (3.6%) had symptoms consistent with active TB disease. Three seniors (0.2%)-each presenting with at least one risk factor-were diagnosed with active TB. The project yielded 146 TB cases per 100,000 seniors screened; the cost per case detected was $4,897. Most workers supported ACF if additional resources and staff could be provided. Seniors appreciated the convenience of this integrated health service approach. Although the yield was lower than expected, ACF appeared feasible in Bayi. Targeting seniors with at least one known TB risk factor could help detect previously unidentified TB cases. However, similar projects in communities with a higher TB prevalence are needed to further evaluate the yield and required resources prior to implementation on a larger scale. Findings from our pilot project should be combined with data from these future ACF projects to improve TB screening criteria.