TB Active Case Finding in Communities: Lessons from an Integrated Community Engagement Approach

Abstract

Background and Challenges to Implementation: The annual incidence of TB in Malawi in 2021 is estimated at 132 per 100,000. Low awareness about TB and its associated risk in the community contributes to low healthcare-seeking behaviour and TB detection gaps. DAPP Malawi is implementing the USAID supported “Mobilizing Local Entities to Improve the Quality, Scale and Sustainability of the TB Response in Malawi,” (Project QSS) which engages a range of community stakeholders to increase TB awareness and supports active TB case finding.

Intervention: DAPP Malawi employs an integrated approach to engage communities in active case finding. Through Project QSS, DAPP Malawi built the capacity of Community Health Workers (CHW), Community Health Volunteers (CHVs), Community-Based Organizations (CBOs), local and religious leaders, and youth clubs to perform different but complementary roles in TB messaging and stigma and discrimination reduction, . DAPP CHWs mentor community stakeholders on TB messaging, systematic screening, sample collection, psychosocial counselling, stigma reduction and contact tracing. Volunteers who manage Community Sputum Collection Points (CSPCs) conduct systematic TB screening, sputum sample collection and transportation, referrals, and contact tracing. CBOs, youth clubs, mother groups, and local and religious leaders complement CHW and CHV efforts by disseminating TB messages and referring people to either CSPCs or the nearest health facility. Local and religious leaders act as influencers to offset misinformation and promote community TB screening services.

Results/Impact: Between January and December 2022, 320,694 people were reached in the communities served by CSCPs volunteers and 52.9% (169,771) were screened for TB; 7.4% (12,557) had symptoms presumptive and; 1.9% (233) were diagnosed with TB and notified compared to only 36 TB cases in 2021.

Conclusions: The integrated and coordinated community-based approach with strong links to local health facilities increased TB awareness, facilitated active case finding and increased case detection by over 6-fold in 2022 compared to 2021.