Improved detection of tuberculosis in primary health care and its impact on the incidence

Abstract

The objective of the study: to determine the potential improvement of tuberculosis detection in primary health care institutions (PHC) through identification of risk groups and screening them for tuberculosis.

Subjects and methods. Tuberculosis incidence in Azerbaijan over 10 years (2006-2015) was retrospectively analyzed. In two districts of Baku (with TB incidence rate of ≤ 30 per 100,000 population), certain activities were performed to confirm that such level of tuberculosis incidence among the local population was true-to-life. The groups of the population with the highest tuberculosis detection rate were identified. In 2016, those groups included: pensioners, housewives, in-country migrants, ex-prisoners, as well as people at the age group 19-24 years old. In 2016, a central register for these groups was created that helped to screen them for tuberculosis in 2017-2018.

Results. The problems interfering with tuberculosis detection in PHC were identified. In this regard, in two districts of Baku with TB incidence ≤ 30, health education among medical personnel and population was intensified, social groups facing the high risk to develop tuberculosis were identified, and laboratory diagnostics of tuberculous mycobacteria tuberculosis (MTB) was improved. For the first time in PHC, the rapid molecular genetic method (GeneXpert MBT/Rif) was used to detect MTB DNA and the predictor of multiple drug resistance. As a result of the events of 2017-2018 aimed to screen risk groups for tuberculosis, the incidence in those two districts among the local population increased by 1.5 times, and in the overall population of both districts – by 1.7 times. After that, the clinical structure of new tuberculosis cases improved. Thus, the rate of focal tuberculosis increased by 3 times. Among extrapulmonary tuberculosis cases, there were no cases of meningitis.