A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam.

Autor: Vo LNQ; Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam. luan.vo@tbhelp.org.; Interactive Research and Development, Ho Chi Minh City, Viet Nam. luan.vo@tbhelp.org., Forse RJ; Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam., Codlin AJ; Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam., Vu TN; Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam., Le GT; Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam., Do GC; Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam., Van Truong V; Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam., Dang HM; Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam., Nguyen LH; Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam., Nguyen HB; National Lung Hospital, Ha Noi, Viet Nam., Nguyen NV; National Lung Hospital, Ha Noi, Viet Nam., Levy J; KNCV Tuberculosefonds, The Hague, The Netherlands., Squire B; Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK., Lonnroth K; Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden., Caws M; Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK.; Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2020 Jun 15; Vol. 20 (1), pp. 934. Date of Electronic Publication: 2020 Jun 15.
DOI: 10.1186/s12889-020-09042-4
Abstrakt: Background: To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale-up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies.
Methods: We conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications.
Results: We verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021).
Conclusions: Both salaried and volunteer CHW human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program. The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje