Early diagnosis and care of tuberculosis through community-based active case-finding using rapid diagnostic tests in urban slums of Phnom Penh, Cambodia

Although globally tuberculosis (TB) incidence and prevalence is declining, the emergence of drugresistant tuberculosis is threatening tuberculosis control efforts. Limited access to rapid diagnostics and health care prevent early diagnosis and treatment of TB and continue to be a pressing issue among poor and vulnerable populations. Innovative approaches such as active case-finding are strongly advocated to overcome some of the barriers but little is known about its perception and acceptability in the community. More evidence is also needed on the best model to fit different epidemiological contexts and the impact active case-finding has on tuberculosis incidence. Moreover, the roll-out of the Xpert® MTB/RIF assay, a new rapid molecular test for the diagnosis of TB and rifampicin-resistant TB, solicits reflection on the best way to target this rapid diagnostic test in patients with suspected TB. It also highlights the need for rapid confirmatory drug susceptibility tests. In 2012, we piloted a community-based active case-finding (ACF) in low socio-economic communities of Phnom Penh, Cambodia. Key features are: community involvement, door-to-door screening and sputum collection, improved microscopy techniques, rapid diagnostic tests, facilitating access to tuberculosis services, and supporting adherence through individual follow-up. We will document the acceptability, feasibility, yield and impact of this community-based ACF strategy on drug-susceptible and drug-resistant tuberculosis case-detection. In addition, we will evaluate the optimal screening strategy of sputum samples in ACF. The last part of our research focuses on evaluating the role of thin layer agar as a rapid, affordable and simple drug susceptibility test in a clinical algorithm with or without Xpert® MTB/RIF.

Trefwoorden:B780-tropische-geneeskunde