Lessons learnt from active tuberculosis case finding in an urban slum setting of Agra city, India.

Active case finding (ACF) is recognized as one of the key strategies to reach the missing 3 million cases in high tuberculosis (TB) burden countries. In India, we conducted ACF as a pilot project to assess its operational feasibility in four slums of Agra city in 2012 and covered 3940 households (in 14 wards) with a population of 21,870. Trained community volunteers visited households with an intention to provide information on TB and refer those with cough ≥2 weeks for sputum smear examination. Volunteers identified 8 persons with cough of ≥2 weeks by asking the first or the main respondent of the household. However, by directly asking (or probing) all available members of the household, they identified 374 persons with cough of ≥2 weeks. All 382 persons with cough of ≥2 weeks were referred for sputum smear examination. While 40% of those referred reached health facilities for sputum examination on their own, 60% had to be accompanied by the community volunteers to the health facility for sputum smear examination by Ziehl-Neelsen staining method. Eventually, seven persons were found to be sputum smear positive. This study highlighted important aspects for implementing ACF: First, all household members have to be asked for TB symptoms and Second, mere referral for sputum examination is not enough and there is a need to support people to reach the health facility for sputum smear examination.