Process evaluation of chest camps for increased tuberculosis case finding in Punjab, Pakistan
Muhammad Amir Khan A , Fouzia Perveen A , Muhammad Ahmar Khan A , Muhammad Jameel A , Nida Khan A * , Zarfishan Tahir B , Hussain Hadi C and Haroon Jehangir Khan DA Association for Social Development, Islamabad, ICT, 44000, Pakistan.
B Provincial TB Control Program, Lahore, 54000, Pakistan.
C National TB Control Program, Islamabad, ICT, 44000, Pakistan.
D Director General Health Services Punjab, Lahore, 54000, Pakistan.
Australian Journal of Primary Health 28(4) 315-320 https://doi.org/10.1071/PY21089
Submitted: 29 April 2021 Accepted: 20 March 2022 Published: 31 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University.
Abstract
Background: To contribute to the World Health Organization’s End TB Strategy, the active tuberculosis (TB) case-finding approach has been proven effective.
Methods: A total of 66 chest camps were organised for patients in 15 selected districts in Punjab, Pakistan, in 2017. A mixed-method process evaluation was conducted in four randomly selected districts to evaluate the use of chest camps for active TB case finding to reach the maximum number of people with TB and to assess the implementation outcomes, such as effectiveness, feasibility, fidelity, and costs.
Results: Results indicated that 1458 attendees visited 24 chest camps in four selected districts. Among attendees, 297 presumptive cases were found and smear-tested; and 34 of the smear-tested were diagnosed as smear-positive TB patients. The prevalence of smear-positive TB patients among the chest camp participants was found to be 2.3%. The findings from interviews showed that preparation of chest camp activities, especially the involvement of community leaders, was found to be effective in achieving the desired level of attendance. The respondents found attending the chest camps for TB symptoms feasible and acceptable. The chest camp costs approximately US$280, including the pre-camp mobilisation events, whereas the cost per TB-positive patient was found to be US$197.64.
Conclusions: The higher number of attendees without TB symptoms, the low proportion of smear-negative case registrations; and relatively high unit cost (per patient detected) were the areas identified for further attention. The study supports the continuation of chest camp activity, with further attention required for quality and efficiency concerns.
Keywords: active case finding, chest camp, community based, developing country, mixed-method study, private clinics, tuberculosis care, urban health.
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