Despite the process made in the last decade, Ghana remains one of the countries with highest tuberculosis (TB) burden in the world. TB case notifications which continue to rely heavily on symptomatic individual’s voluntarily seeking care at health facilities as advocated by the World Health Organization have stagnated. Several prevalence surveys, including Ghana’s latest, revealed up to 50% of tuberculosis remains undiagnosed despite widespread implementation of DOT. This passive facility- Based case detection has proven inadequate to control TB.
TB tends to concentrate in poor and marginalized communities who face many barriers to access health services such as lack of awareness, competing priorities for time and money, disconnection with health services due to lack regular service and experienced personnel. Innovative strategies complementing facility- Based case detection are needed. One such strategy, active case finding (ACF) – which involves systematically searching for TB in individuals who would not spontaneously present to a health service and bringing them in to care- has gained interest in high prevalence countries in the last decade. ACF aims to reduce barriers for early TB case detection, including delay in presentation to a health facility, identification of a person as a presumptive TB case and timely diagnosis and subsequent treatment. While showing significant promise as a tool to improve also be ensured to be effective and have an impact on TB transmission in the community. Linking diagnosis to treatment has reportedly been challenging in community- Based TB screening interventions with high initial loss to follow-up rates.
In places with an existing strong DOTS system, treatment outcomes were good. So far, little is understood about how to best apply and integrate ACF in the existing health care system in diverse epidemiologic, socio-economic and cultural context.
Early detection of TB requires appropriate diagnostic tools. In many high burden countries including Ghana smear microscopy remains the cornerstone of diagnosis. More sensitive and rapid diagnostics have become available but an affordable and accurate point –of- care test for TB is still lacking. The revolutionary development of the GeneXert MTB/RIF assay (further referred to as Xpert), a rapid and fully automated molecular test that simultaneously detects TB and Rifampicin resistance, has definitely been a game- changer in this field.
In a recent publication on systematic screening for active TB, World Health Organization addresses the issue and provides key recommendations on risk groups to be screened and algorithms (including Xpert) that can be used in ACF. Although an important step in guiding screening for active TB there is still need for more research on new screening approaches and tools, and more evidence on the impact of screening.