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Quantifying the potential epidemiological impact of a 2-year active case finding for tuberculosis in rural Nepal: a model-based analysis

Shrestha, Sourya, Mishra, Gokul, Hamal, Mukesh, Dhital, Raghu, Shrestha, Suvesh, Shrestha, Ashish, Shah, Naveen Prakash, Khanal, Mukti, Gurung, Suman and Caws, Maxine ORCID: (2023) 'Quantifying the potential epidemiological impact of a 2-year active case finding for tuberculosis in rural Nepal: a model-based analysis'. BMJ Open, Vol 13, Issue 11, e062123.

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Active case finding (ACF) is an important tuberculosis (TB) intervention in high-burden settings. However, empirical evidence garnered from field data has been equivocal about the long-term community-level impact, and more data at a finer geographic scale and data-informed methods to quantify their impact are necessary.

Using village development committee (VDC)-level data on TB notification and demography between 2016 and 2017 in four southern districts of Nepal, where ACF activities were implemented as a part of the IMPACT-TB study between 2017 and 2019, we developed VDC-level transmission models of TB and ACF. Using these models and ACF yield data collected in the study, we estimated the potential epidemiological impact of IMPACT-TB ACF and compared its efficiency across VDCs in each district.

Cases were found in the majority of VDCs during IMPACT-TB ACF, but the number of cases detected within VDCs correlated weakly with historic case notification rates. We projected that this ACF intervention would reduce the TB incidence rate by 14% (12–16) in Chitwan, 8.6% (7.3–9.7) in Dhanusha, 8.3% (7.3–9.2) in Mahottari and 3% (2.5–3.2) in Makwanpur. Over the next 10 years, we projected that this intervention would avert 987 (746–1282), 422 (304–571), 598 (450–782) and 197 (172–240) cases in Chitwan, Dhanusha, Mahottari and Makwanpur, respectively. There was substantial variation in the efficiency of ACF across VDCs: there was up to twofold difference in the number of cases averted in the 10 years per case detected.

ACF data confirm that TB is widely prevalent, including in VDCs with relatively low reporting rates. Although ACF is a highly efficient component of TB control, its impact can vary substantially at local levels and must be combined with other interventions to alter TB epidemiology significantly.

Item Type: Article
Subjects: WA Public Health > WA 105 Epidemiology
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
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Dataset for the article: Quantifying the potential epidemiological impact of a two-year active case finding for tuberculosis in rural Nepal: A model-based analysis
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
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Depositing User: JISC Pubrouter
Date Deposited: 07 Nov 2023 15:19
Last Modified: 07 Nov 2023 16:09


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