Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups – The Romanian Experience

Abstract

Introduction

Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas.

Methods

The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests.

Results

The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1).

Discussion

These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions.

Keywords:

• active screening
• vulnerable populations
• socio-demographic analysis
• GeneXpert
• intervention health strategies
• tuberculosis

Abbreviations

TB, tuberculosis; ACF, active case finding; DR-TB, drug-resistant tuberculosis; MDR/RR-TB, multidrug- or rifampicin-resistant tuberculosis; WHO, World Health Organization; CXR, chest radiography; HIV, human immunodeficiency virus; CAD, computer-aided detection; mWRDs, WHO recommended molecular rapid diagnostic tests for tuberculosis; EU, Europe; EEA, East Economic Area; NTP, National TB Program; MoH, Ministry of Health; HP, homeless people; PWID, people who inject drugs; RR, rural residents; PDL, People deprived of liberty; LTB, latent tuberculosis; VG, vulnerable groups; ATU, administrative-territorial unit.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of “Marius Nasta” Institute of Pneumology (No.: 23935/25.10.2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Acknowledgments

We would like to thank all our collaborators: Popescu Gilda Georgeta, Cioran Nicoleta, Ciomaga Mirela, Gramada Mirela, Botezatu Elena, Sorete Adriana, Apostu Marius, Marza Aurelia, Ursescu Vasile, Lefter Marta, Cos Madalina, Boboc Virginia, Luca Florina, Dumitrache Elena, Micu Marioara, Bolgiu Dana, Ivascu Daniela, Nedelea Adelina, Rebedea Cristina, Tiganila Robert George, Balta Madalina Andreia, Popa Dan, Popescu Maria, Lupu Emil, Grecu Victor, Eparu Ion, Lung Camelia, Socaci Adriana, Culea Cosmina, Silvestru Felicia, Ioan Sergiu Danut, Hodisan Vasile, Szekely Alexandru, Ariesanu Nicoleta, Anbrus Violeta, Dragos Madalina, Ianosi Edith, Popescu Alexandra, Buga Sebastian Aristide, Szanto Maria, Barko-Iza Adina, Macavei Tania, Tudorache Mirela, Lichiardopol Aristita, Stefanescu Adrian, Butum Lavinia, Plesita Andreea, Nita Camelia, Eddan Athir, Teoibas Carmen, Leonte Iustina, Danciu Lavinia, Sturz Ciprian, Gligor Elena, Găvriluț Amalia, Trăistaru Cătălin Gabriel, Cotuna Florica Luminita, Țale Ramona, Ozunu Daniel, Blidaru Liliana, Stoica Ioana, Nedelea Adelina, Draganoaia Maria Steluta, Dan Valeriu Ionescu, Archip Mihaela, Rusu Cristina, Cojocaru Cristian, Ursărescu Bianca, Popovici George, Preda Beniamin, Pătrașcă Georgeta, Barsan Mihaela.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was funded by EU funds, POCU Program, Grant number SMIS Code 2014+: 117426.