Comparing yield and relative costs of WHO TB screening algorithms in selected risk groups among people aged 65 years and over in China, 2013.

To calculate the yield and cost per diagnosed tuberculosis (TB) case for three World Health Organization screening algorithms and one using the Chinese National TB program (NTP) TB suspect definitions, using data from a TB prevalence survey of people aged 65 years and over in China, 2013.This was an analytic study using data from the above survey. Risk groups were defined and the prevalence of new TB cases in each group calculated. Costs of each screening component were used to give indicative costs per case detected. Yield, number needed to screen (NNS) and cost per case were used to assess the algorithms.The prevalence survey identified 172 new TB cases in 34,250 participants. Prevalence varied greatly in different groups, from 131/100,000 to 4651/ 100,000. Two groups were chosen to compare the algorithms. The medium-risk group (living in a rural area: men, or previous TB case, or close contact or a BMI <18.5, or tobacco user) had appreciably higher cost per case (USD 221, 298 and 963) in the three algorithms than the high-risk group (all previous TB cases, all close contacts). (USD 72, 108 and 309) but detected two to four times more TB cases in the population. Using a Chest x-ray as the initial screening tool in the medium risk group cost the most (USD 963), and detected 67% of all the new cases. Using the NTP definition of TB suspects made little difference.To "End TB", many more TB cases have to be identified. Screening only the highest risk groups identified under 14% of the undetected cases,. To "End TB", medium risk groups will need to be screened. Using a CXR for initial screening results in a much higher yield, at what should be an acceptable cost

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

BACKGROUND: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. METHODS: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. RESULTS: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. CONCLUSIONS: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

Number of tests to be taken, yield and cost per case for each algorithm of the medium risk group 1, high risk group 2 and all aged 65 and over.

<p>Number of tests to be taken, yield and cost per case for each algorithm of the medium risk group 1, high risk group 2 and all aged 65 and over.</p

Algorithms to screen the population for TB aged 65 or over in the different high risk group in this study, based on the WHO recommendations.

<p>Algorithms to screen the population for TB aged 65 or over in the different high risk group in this study, based on the WHO recommendations.</p

The sampling procedure of the TB prevalence survey in China in 2013.

<p>(*) 10 out of 31 provinces were selected, by considering the cooperative willingness, human resources and related abilities of each province.</p

Risk group 1 and 2, and yield, and prevalence of new TB cases, for each group.

<p>Risk group 1 and 2, and yield, and prevalence of new TB cases, for each group.</p

Number in each risk group, number of new TB cases diagnosed and, prevalence of new TB cases, in the prevalence survey China, 2013.

<p>Number in each risk group, number of new TB cases diagnosed and, prevalence of new TB cases, in the prevalence survey China, 2013.</p

Demographic characteristics of the population aged 65 or over in the sample population in China in 2013.

<p>Demographic characteristics of the population aged 65 or over in the sample population in China in 2013.</p

The location of 10 sample counties in the TB prevalence survey in China in 2013.

<p>The location of 10 sample counties in the TB prevalence survey in China in 2013.</p

Cost of each component of active TB case-finding in this study in China in 2013.

<p>Cost of each component of active TB case-finding in this study in China in 2013.</p