Former TB patients improve TB case detection in rural and mining communities of Eastern Democratic Republic of Congo

In the context of rural and mining communities of the South-Kivu province in the Democratic Republic of Congo (DRC), the province has case notification rates that are 25% of the national incidence estimates possibly due to poor access to health services. Active case finding (ACF) consists of screening for TB outside the traditional health facilities. This approach has shown to be very effective to increase TB detection in other African settings with low detection rates. Through a TB REACH grant, we involved former TB patients to actively screen people for TB symptoms in their community. Methods: The intervention was implemented in 19 sub-districts that had no history of participation with ACF interventions. These areas provide care to an estimated population of 1.2 million, comprising rural and mining communities. Starting progressively in April 2012, 240 volunteer former TB patients were recruited to perform verbal screening for TB symptoms in their community and referral of suspects for smear microscopy and GeneXpert testing. Volunteers received financial support for the logistical costs linked to their activities (mainly reimbursement of local transport costs). Project staff supervised them regularly. National TB Program (NTP) notification data from these facilities were modeled to measure changes in notification trends pre- and post- ACF intervention. Results: During quarters 3 & 4 of 2012, 18,261 verbal screening events were conducted by former TB patients, resulting in the detection of 1,361 (7.5%) suspects with symptoms suggestive of TB. All newly identified TB suspects were referred for smear microscopy testing. The intervention significantly increased the rate of case notification. Regression analysis shows a 3.7% declining trend over two years was replaced by an estimated 20.2% growth quarter on quarter post-implementation (p