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Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding
BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular appro...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763441/ https://www.ncbi.nlm.nih.gov/pubmed/26905034 http://dx.doi.org/10.1186/s12889-016-2769-7 |
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author | Adejumo, A. O. Azuogu, B. Okorie, O. Lawal, O. M. Onazi, O. J. Gidado, M. Daniel, O. J. Okeibunor, J. C. Klinkenberg, E. Mitchell, E. M. H. |
author_facet | Adejumo, A. O. Azuogu, B. Okorie, O. Lawal, O. M. Onazi, O. J. Gidado, M. Daniel, O. J. Okeibunor, J. C. Klinkenberg, E. Mitchell, E. M. H. |
author_sort | Adejumo, A. O. |
collection | PubMed |
description | BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. METHODS: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. RESULTS: CWs referred 4–22 % of presumptive TB clients tested, and 4–24 % of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. CONCLUSION: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding. |
format | Online Article Text |
id | pubmed-4763441 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47634412016-02-24 Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding Adejumo, A. O. Azuogu, B. Okorie, O. Lawal, O. M. Onazi, O. J. Gidado, M. Daniel, O. J. Okeibunor, J. C. Klinkenberg, E. Mitchell, E. M. H. BMC Public Health Research Article BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. METHODS: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. RESULTS: CWs referred 4–22 % of presumptive TB clients tested, and 4–24 % of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. CONCLUSION: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding. BioMed Central 2016-02-23 /pmc/articles/PMC4763441/ /pubmed/26905034 http://dx.doi.org/10.1186/s12889-016-2769-7 Text en © Adejumo et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Adejumo, A. O. Azuogu, B. Okorie, O. Lawal, O. M. Onazi, O. J. Gidado, M. Daniel, O. J. Okeibunor, J. C. Klinkenberg, E. Mitchell, E. M. H. Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding |
title | Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding |
title_full | Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding |
title_fullStr | Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding |
title_full_unstemmed | Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding |
title_short | Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding |
title_sort | community referral for presumptive tb in nigeria: a comparison of four models of active case finding |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763441/ https://www.ncbi.nlm.nih.gov/pubmed/26905034 http://dx.doi.org/10.1186/s12889-016-2769-7 |
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