An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.

<h4>Background</h4>In Pakistan, like many Asian countries, a large proportion of healthcare is provided through the private sector. We evaluated a systematic screening strategy to identify people with tuberculosis in private facilities in Karachi and assessed the approaches' ability...

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Autores principales:	Jacob Creswell, Saira Khowaja, Andrew Codlin, Rabia Hashmi, Erum Rasheed, Mubashir Khan, Irfan Durab, Christina Mergenthaler, Owais Hussain, Faisal Khan, Aamir J Khan
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e8d0517be06f447f821ad27984ddeb2c
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spelling	oai:doaj.org-article:e8d0517be06f447f821ad27984ddeb2c2021-11-18T08:24:48ZAn evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.1932-620310.1371/journal.pone.0093858https://doaj.org/article/e8d0517be06f447f821ad27984ddeb2c2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24705600/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>In Pakistan, like many Asian countries, a large proportion of healthcare is provided through the private sector. We evaluated a systematic screening strategy to identify people with tuberculosis in private facilities in Karachi and assessed the approaches' ability to diagnose patients earlier in their disease progression.<h4>Methods and findings</h4>Lay workers at 89 private clinics and a large hospital outpatient department screened all attendees for tuberculosis using a mobile phone-based questionnaire during one year. The number needed to screen to detect a case of tuberculosis was calculated. To evaluate early diagnosis, we tested for differences in cough duration and smear grading by screening facility. 529,447 people were screened, 1,010 smear-positive tuberculosis cases were detected and 942 (93.3%) started treatment, representing 58.7% of all smear-positive cases notified in the intervention area. The number needed to screen to detect a smear-positive case was 124 (prevalence 806/100,000) at the hospital and 763 (prevalence 131/100,000) at the clinics; however, ten times the number of individuals were screened in clinics. People with smear-positive TB detected at the hospital were less likely to report cough lasting 2-3 weeks (RR 0.66 95%CI [0.49-0.90]) and more likely to report cough duration >3 weeks (RR 1.10 95%CI [1.03-1.18]). Smear-positive cases at the clinics were less likely to have a +3 grade (RR 0.76 95%CI [0.63-0.92]) and more likely to have +1 smear grade (RR 1.24 95%CI [1.02-1.51]).<h4>Conclusions</h4>Tuberculosis screening at private facilities is acceptable and can yield large numbers of previously undiagnosed cases. Screening at general practitioner clinics may find cases earlier than at hospitals although more people must be screened to identify a case of tuberculosis. Limitations include lack of culture testing, therefore underestimating true TB prevalence. Using more sensitive and specific screening and diagnostic tests such as chest x-ray and Xpert MTB/RIF may improve results.Jacob CreswellSaira KhowajaAndrew CodlinRabia HashmiErum RasheedMubashir KhanIrfan DurabChristina MergenthalerOwais HussainFaisal KhanAamir J KhanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 4, p e93858 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jacob Creswell Saira Khowaja Andrew Codlin Rabia Hashmi Erum Rasheed Mubashir Khan Irfan Durab Christina Mergenthaler Owais Hussain Faisal Khan Aamir J Khan An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.
description	<h4>Background</h4>In Pakistan, like many Asian countries, a large proportion of healthcare is provided through the private sector. We evaluated a systematic screening strategy to identify people with tuberculosis in private facilities in Karachi and assessed the approaches' ability to diagnose patients earlier in their disease progression.<h4>Methods and findings</h4>Lay workers at 89 private clinics and a large hospital outpatient department screened all attendees for tuberculosis using a mobile phone-based questionnaire during one year. The number needed to screen to detect a case of tuberculosis was calculated. To evaluate early diagnosis, we tested for differences in cough duration and smear grading by screening facility. 529,447 people were screened, 1,010 smear-positive tuberculosis cases were detected and 942 (93.3%) started treatment, representing 58.7% of all smear-positive cases notified in the intervention area. The number needed to screen to detect a smear-positive case was 124 (prevalence 806/100,000) at the hospital and 763 (prevalence 131/100,000) at the clinics; however, ten times the number of individuals were screened in clinics. People with smear-positive TB detected at the hospital were less likely to report cough lasting 2-3 weeks (RR 0.66 95%CI [0.49-0.90]) and more likely to report cough duration >3 weeks (RR 1.10 95%CI [1.03-1.18]). Smear-positive cases at the clinics were less likely to have a +3 grade (RR 0.76 95%CI [0.63-0.92]) and more likely to have +1 smear grade (RR 1.24 95%CI [1.02-1.51]).<h4>Conclusions</h4>Tuberculosis screening at private facilities is acceptable and can yield large numbers of previously undiagnosed cases. Screening at general practitioner clinics may find cases earlier than at hospitals although more people must be screened to identify a case of tuberculosis. Limitations include lack of culture testing, therefore underestimating true TB prevalence. Using more sensitive and specific screening and diagnostic tests such as chest x-ray and Xpert MTB/RIF may improve results.
format	article
author	Jacob Creswell Saira Khowaja Andrew Codlin Rabia Hashmi Erum Rasheed Mubashir Khan Irfan Durab Christina Mergenthaler Owais Hussain Faisal Khan Aamir J Khan
author_facet	Jacob Creswell Saira Khowaja Andrew Codlin Rabia Hashmi Erum Rasheed Mubashir Khan Irfan Durab Christina Mergenthaler Owais Hussain Faisal Khan Aamir J Khan
author_sort	Jacob Creswell
title	An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.
title_short	An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.
title_full	An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.
title_fullStr	An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.
title_full_unstemmed	An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.
title_sort	evaluation of systematic tuberculosis screening at private facilities in karachi, pakistan.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/e8d0517be06f447f821ad27984ddeb2c
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An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.

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