Identifying and mapping the target population for ACF campaign

Active case-finding (ACF) approaches bring essential TB services closer to the community. It has high potential for improving TB case detection and reach people with TB currently missed by the health system. To maximize gains from ACF, it is important that the interventions are planned in advance. 

Planning for ACF includes identifying the right target population/area, designing the intervention, finding the right implementing partners, training of workforce, microplanning for daily activities, logistics, ensuring that the complete pathway of care is followed, reporting and recording.

Steps involved in planning for ACF

1. Identification of population based on:

a. increased risk for TB eg: prisoners, miners, urban slums, co-morbidities like HIV, diabetes etc.

b. those with limited access to health services eg: migrants, homeless, tribal, live in hard to reach areas etc.

2. Identification of stakeholders including district and sub-district TB program staff, non-government organizations, community based organizations, community health workers to support with ACF activities

3. Strengthening the health system e.g. training of staff, ensuring sufficient lab supply and lab technicians. Staff trainings should be done to eliminate gaps in knowledge about TB, cough hygiene, infection control measures, conducting screening, collecting quality sputum, transporting sputum or referring people with presumptive TB to the health facility/laboratory, TB testing, data collection, data entry 

4. Microplanning for ACF includes:

a. when and where to conduct ACF-day, time, duration, methodology-camp, door-to-door, community gatherings, home visits, place of work etc

b. availability of trained manpower, team composition, logistics and consumables

c. screening and diagnostic algorithm to be used

d. number of screenings and tests done per day

e. accessibility and linkage with TB testing laboratories, use of mobile van with CXR, CBNAAT/Truenat 

f. laboratory workload to accommodate additional testing due to ACF

g. laboratory turn around time, availability of test reports for clinical management 

h. advocacy on ACF activities with the target population, pre-sensitization meetings, addressing perceived risks of TB screening and diagnosis (e.g. job loss, loss of income)

i. data collection tools (paper based, smartphones, tablets etc.), TB notification, recording and reporting

Resources

1. Systematic screening for active tuberculosis: an operational guide (http://www.who.int/tb/publications/ systematic_screening/en/)

2. Experience of active tuberculosis case finding in nearly 5 million households in India (Prasad BM, Satyanarayana S, Chadha SS, Das A, Thapa B, Mohanty S, et al. Public Health Action. 2016;6(1):15–8. doi:10.5588/pha/15/0035)

3. Community-wide screening for tuberculosis in a high-prevalence setting (Marks GB, Nguyen NV, Nguyen PTB, et al. N Engl J Med 2019; 381: 1347-57)

Assessment