TB-Free Chuuk: community-wide tuberculosis prevention and treatment with an integrated disease screening approach in Chuuk Lagoon, Federated States of Micronesia

Introduction Tuberculosis (TB) is a global public health threat and a leading cause of morbidity and mortality. To reduce long-term TB burden and address related diseases in Chuuk, Federated States of Micronesia, a community-wide campaign was conducted, incorporating an integrated approach to screening and treatment for TB disease, TB infection (TBI), Hansen’s disease (HD) and diabetes. Here we present its design and initial outcomes. Methods Public health workers administered tuberculin skin tests (TSTs) door-to-door among persons residing in areas of high TB incidence in the Chuuk Lagoon islands. Persons then attended a local screening site and were assessed for TB (TST measurement, verbal symptom review and chest x-ray, where indicated), HD (skin exam for rash or other cutaneous findings) and diabetes (haemoglobin A1c for adults). Persons diagnosed with either TB disease or TBI were offered treatment on-site. Persons with exam findings consistent with HD were referred for evaluation. Persons with a haemoglobin A1c of ≥6.5% were referred for follow-up. Results During May–October 2023, 12 319 persons were screened through the community-wide campaign. An on-site panel of expert clinicians diagnosed 184 persons with TB disease and 2134 persons with TBI. Among those diagnosed with TB disease, 76.6% completed treatment. Among those diagnosed with TBI, 74.6% completed once-weekly rifapentine with isoniazid (3HP) treatment from community health workers. 17 new cases of HD and 395 new cases of diabetes were diagnosed. Conclusions This cross-sectional analysis of the TB-Free Chuuk campaign demonstrated the success of community-wide screening to identify new cases of TB disease, TBI, HD and diabetes. Integrated screening provided the opportunity to address related public health priorities simultaneously, increasing the community’s public health benefit. The development of local health worker capacity was key to achieving high treatment completion. Similar campaigns could be considered for other areas with high TB incidence with the goal of accelerating pathways to TB elimination.