Community-based active case-finding to reach the most vulnerable: tuberculosis in tribal areas of India

BACKGROUND: India has the world's largest indigenous/tribal population. Many areas with large tribal populations suffer from weak infrastructure and services. Surveys have shown a high prevalence of TB among Saharia communities, who rarely access public services. We evaluated a community-based active TB case-finding intervention. METHODS: Community health workers screened people for TB symptoms in Saharia communities, made referrals, collected sputum for transport to laboratories, and initiated and supported anti-tuberculosis treatment. Microscopy testing was performed at government laboratories. The intervention tracked the people screened, referrals, the people tested, laboratory results, treatment initiation and outcomes. RESULTS: Community health workers verbally screened 65 230 people, 8723 (13%) of whom had symptoms. Of these, 5600 were tested, 964 (17%) of whom were smear-positive. During the intervention, we observed a +52% increase in people tested at laboratories and an +84% increase in TB case notifications. Pre-treatment loss to follow-up decreased and treatment success increased slightly. CONCLUSIONS: In India, particularly among tribal populations, many people with TB are missed by current approaches due to poor access. Community-based active case-finding can help identify more people with TB in tribal and remote rural areas by addressing barriers to health seeking as well as help reach ambitious country and global notification targets.