Early and increased tuberculosis case detection: Implementation, measurement, and evaluation

Despite substantial millions of people being treated by National Tuberculosis Control Programs (NTPs) and their partners over the last 25 years and millions of lives being saved, tuberculosis (TB) continues to be a leading cause of morbidity and mortality in many low- and middle-income countries and is currently estimated to kill 1.5 million people a year. Globally, the number of people diagnosed and notified to NTPs has hardly changed since 2007, meaning that more than three million people are ‘missed’ every year.
While there are a number of well-designed research projects around improving case detection that have shown good results, the impact of wider programmatic initiatives on improving case detection in the post-DOTS expansion era have not been widely considered with only one community randomized controlled trial finding no significant impact on TB incidence of an enhanced case finding intervention.
Different approaches need to be evaluated and findings discussed. How these findings may be applicable to national and global level policy needs further evaluation.
This research has been done using TB REACH projects as a platform. TB REACH is in an initiative of the Stop TB Partnership that provides one year grants through an independent competitive selection process to institutions and organizations involved in TB control who present proposals aimed at increasing case finding. The initiative encourages local innovation and solutions that may not be funded elsewhere and requires detailed reporting on technical and financial progress and case finding data and an external dedicated monitoring and evaluation agency ensures the veracity of the data.