Detecting undiagnosed tuberculosis (TB) cases has been a central focus of Ethiopia's national strategy to end TB, with targeted screening carried out at selected sites using both symptom-based and diagnostic tool-based approaches. This study aimed to evaluate the outcomes of a national TB screening program in identifying previously undetected cases across the country. A contact screening study was conducted using routine program data and active community-based screening among individuals living in TB hotspot areas. Districts were selected based on the TB case load reported over the previous two years, with inclusion criteria requiring at least 20 bacteriologically confirmed pulmonary TB cases. In total, 750 districts representing 73.3% of all districts nationwide were included in the search for undetected TB cases, conducted between April 1 and June 30, 2024. All health facilities within the selected districts participated in the study. The study included contacts of individuals diagnosed with bacteriologically confirmed pulmonary TB and drug-resistant TB within the past two years, as well as members of the community residing in TB hotspot areas. Sputum samples were collected from all participants, and TB diagnosis was performed using Ziehl-Neelsen smear microscopy and/or GeneXpert Ultra testing. Data sources included TB registers from TB clinics for contact screening and primary data collected at central locations designated for community-based screening. Data were standardized to calculate TB detection rates per 100,000 population. Odds ratios (ORs) were also computed to compare detection rates between contact-based and community-based screening approaches though binary logistic regression. All newly detected TB patients, along with eligible children for tuberculosis preventive therapy (TPT), were linked to appropriate treatment services. A total of 439,622 people were screened through household contact screening, and 1,731,616 through active community-based screening. Of the 8707 TB cases diagnosed, 64% were identified through household contact screening, and 36% through community-based screening. The prevalence was 1.30% (1,309 per 100,000) for household contact screening and 0.17% (170 per 100,000) for community-based screening. A high proportion of TB cases were bacteriologically confirmed in both methods: 76.6% in contact screening and 64.3% in community-based screening. Of all diagnosed cases, 8,003 individuals (91.9%) began treatment. The study also screened 68,330 children under 15 years and 43% of the total screened were eligible, and 67% of those eligible were initiated on TPT. Factors significantly associated with TB acquisition included: age over 15 years (adjusted odds ratio (AOR) = 1.76, P < 0.001), male gender (AOR = 1.18, P < 0.001), and contact with bacteriologically confirmed TB cases (AOR = 1.86, P < 0.001). This study shows that national TB screening strategies, especially those targeting household contacts and using active, community-based approaches with smear microscopy and GeneXpert, can effectively enhance detection of both drug-sensitive and drug-resistant TB.
Janfa et al. (Sun,) studied this question.