Tuberculosis active case-finding among Afghan refugees in Pakistan: Care cascade, characteristics and treatment outcomes

OBJECTIVES: Afghan refugees in Pakistan face a high burden of tuberculosis (TB) due to displacement, overcrowding, and limited healthcare access. This study evaluates the effectiveness of Active Case Finding (ACF) implemented under the Global Fund-supported Multi-Country Grant, targeting Afghan refugees in 45 refugee villages across Khyber Pakhtunkhwa and Balochistan provinces in Pakistan, during 2019-2024. METHODS: A longitudinal descriptive study involving secondary data from the National TB Program was conducted. Trained health workers screened communities for TB symptoms, and presumptive cases were referred for diagnosis using smear microscopy, GeneXpert, and chest X-ray. TB patients received standardized treatment and follow-up under DOT. Data were analyzed using STATA v12.1. RESULTS: Of 612,965 refugees, 560,000 (91%) were screened; 4860 TB patients were identified (NNS = 115). Pulmonary TB accounted for 76% of cases; 52% were female, and 43% were aged 15-44. Treatment outcomes were available for 4062 TB patients, with a 97% favourable outcome rate, exceeding WHO's 90% target. CONCLUSION: Community-based ACF among Afghan refugees proved effective in detecting TB and achieving high treatment success. The intervention demonstrates the value of targeted outreach in improving TB care among refugees and underserved populations.