The Impact of Active Case-Finding of Pulmonary Tuberculosis on the Epidemic Risk and Treatment Outcomes in a Big Industrial Region (Kuzbass)

The objective: to study effects associated with active case-finding of pulmonary tuberculosis patients among adult population (the impact on the epidemiological risk and treatment outcomes). Subjects and Methods: Data from the register of tuberculosis patients in Kemerovo Region for 2014-2022 were retrospectively analyzed. Methods of descriptive statistics, logistic regression and survival analysis were used the access the data. The authors compared two groups of pulmonary tuberculosis patients, those were detected by active case-finding and those detected when seeking medical care. Results: The study included data from 17,654 adult new pulmonary tuberculosis patients registered in Kemerovo Region from 2014 to 2022. Of them, 7,657 were detected through active case-finding and 8,892 were identified when seeking medical care. In the patients detected actively, 25.0% of cases had a positive result of sputum smear, while this rate made 55.0% of cases among those detected by self-referral. Destructive changes in the lungs were observed in 33.7% and 48.5%, respectively (OR = 0.54), fibrous cavernous tuberculosis in 0.5% and 5.1%, respectively (OR = 0.09). The following treatment outcomes were reported: successful treatment was reported in 73.9% of patients detected actively and in 44.1% of those detected by self-referral. Active case-finding, independent of other factors, contributed to the reduction of risks of treatment failure (aOR=0.85; p=0.016), death (aOR=0.19; p<0.001), and loss to follow-up (aOR=0.75; p<0.001).