ArticleBMJ open2020
Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Active Case Finding for Tuberculosis in Migrants: a Systematic Review.Medical archives (Sarajevo, Bosnia and Herzegovina) · 2024Pooled it
- Effectiveness of a structured gastric aspirate training on diagnosis of paediatric tuberculosis among healthcare workers in rural Chhattisgarh.The Indian journal of medical research · 2026Article
- "Fragmented care pathway in a layered TB care system": a grounded theory approach to understand care pathways and delays in TB care in Odisha.BMC health services research · 2026Article
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- Costs and cost-effectiveness of community health worker programs focussed on HIV, TB and malaria infectious diseases in low- and middle-income countries (2015-2024): A scoping literature review.PLOS global public health · 2025Article
- Active screening of presumptive tuberculosis cases in rural communities through youth club members in India: logic model development and feasibility study.Frontiers in public health · 2025Article
- Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems.BMC health services research · 2024Article
- Factors associated with Community Health Agents' knowledge about tuberculosis.Revista brasileira de enfermagem · 2024Article
- Implementation of evidence-based multiple focus integrated intensified TB screening to end TB (EXIT-TB) package in East Africa: a qualitative study.BMC infectious diseases · 2023Article
- A systematic review and meta-analysis of active case finding for tuberculosis in India.The Lancet regional health. Southeast Asia · 2022Article
- Gaps and Interventions across the Diagnostic Care Cascade of TB Patients at the Level of Patient, Community and Health System: A Qualitative Review of the Literature.Tropical medicine and infectious disease · 2022Review
- Feasibility of a randomized clinical trial evaluating a community intervention for household tuberculosis child contact management in Cameroon and Uganda.Pilot and feasibility studies · 2022Article
- Can Patient Navigators Help Potential TB Patients Navigate the Diagnostic and Treatment Pathways? An Implementation Research from India.Tropical medicine and infectious disease · 2021Article
- Engagement and Preparedness of Urban Accredited Social Health Activists (U-ASHAs) for Delivery of Tuberculosis (TB) Care: Findings From two Cities in Maharashtra, India.Indian journal of community medicine : official publication of Indian Association of Preventive & Social MedicineArticle
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesCost-efficient active case finding (ACF) approaches are needed for their large-scale adoption in national tuberculosis (TB) programmes. Our aim was to assess if community health workers' (CHW) knowledge about families' health status can improve the cost efficiency of the ACF programme without adversely affecting the delivery of other health services for which they are responsible.
designQuasi-experimental design.
interventionsWe evaluated an ACF programme in the Samastipur district in Bihar, India, between July 2017 and June 2018. CHWs called Accredited Social Health Activists generated referrals of individuals at risk of TB and conducted symptom-based screening to identify patients with presumptive TB. They also helped them undergo testing and provided treatment support for confirmed TB cases. PRIMARY AND SECONDARY OUTCOME MEASURES: We compared the notification rate from the intervention region with that from a control region in the same district with similar characteristics. We analysed operational data to calculate the cost per TB case diagnosed. We used routine programmatic data from the public health system to estimate the impact on other services provided by CHWs.
findingsCHWs identified 9895 patients with presumptive TB. Of these, 5864 patients were tested for TB, and 1236 were confirmed as TB cases. Annual public case notification rate increased sharply in the intervention region from 45.8 to 105.8 per 100 000 population, whereas it decreased from 50.7 to 45.3 in the control region. There was no practically or statistically significant impact on other output indicators of the CHWs, such as institutional deliveries (-0.04%). The overall cost of the intervention was about US$134 per diagnosed case. Main cost drivers were human resources, and commodities (drugs and diagnostics), which contributed 37.4% and 32.5% of the cost, respectively.
conclusionsACF programmes that use existing CHWs in the health system are feasible, cost efficient and do not adversely affect other healthcare services delivered by CHWs.
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