3.4 Methods of case finding

TB can affect anyone but certain groups of people are more likely to develop tuberculosis. These vulnerable groups include:

• Household contacts: Tracing & investigating household contacts of index cases
• Children (all age group, especially under 5 years) and adolescents – to be prioritised in all active case finding activities
• Elderly (65 and above) – to be prioritised in all active case finding activities
• Slum dwellers – Active case finding (household visit, outreach smearing centre, mobile van) to be carried out at least once every quarter
• Homeless/floating population – outreach mobile vans / sputum smear centres in stations / terminals etc.
• People living in congregate setting (prisons, hostels, orphanages etc.) – screening/contact tracing/ use of outreach mobile vans
• People with chronic diseases, such as Diabetes, COPD, malnutrition – to be prioritised during all active case finding activities
• Factory / garments workers - screening/ contact tracing/ mobile van
• People in hard-to-reach area – Special Campaigns / outreach sputum smear centers / contact tracing
• Migrants – Mobile van / outreach sputum smear centers

The most important method of case finding is identification of symptomatic patients attending a health facility, either on their own initiative or referred by another health facility, health worker, community volunteer, etc. Patients diagnosed with any form of TB should always be asked whether there is anybody living in the same house that has a chronic cough and be encouraged to bring or send that person to the health facility for sputum examination and/or other investigation(s).

All child household contacts of smear-positive patients should be examined for possible signs of TB. The same applies to all household contacts of identified DR TB patients. Thus these should be active approaches. In case these contacts cannot attend the health facility, the health worker or community volunteer involved in TB control should visit the house of the patient and identify persons with symptoms suggestive of TB.

All health workers and community volunteers should be encouraged to identify and refer presumptive TB patients to an appropriate health facility for sputum examination and/or other investigation(s) for early diagnosis and treatment to prevent further spread of the infection.

By medical staff

It is the responsibility of medical doctors (with paramedic and other field level staff) of government health facilities and staff of NGO facilities involved in the NTP to identify presumptive TB patients at the health facilities and to arrange for appropriate investigations like Chest X-Ray (CXR), smear microscopy and WRDs (Xpert MTB/RIF assay and TrueNat) at the nearest diagnostic facilities. In addition, they also need to facilitate these investigations for presumptive TB cases referred by different health providers and volunteers. Extra-pulmonary presumptive TB should be referred to the appropriate facility/specialist for diagnosis. In addition, identification of presumptive TB cases, their sputum examination and referral for diagnosis of presumptive extra-pulmonary TB are also the responsibility of medical doctors of academic institutes, prisons, defence, corporate sectors and private practitioners through direct collaboration with the NTP and / or partner NGOs.

By non-medical persons

Community awareness and participation plays an important role in identification of presumptive TB cases and motivating them to visit the nearest health facility and have their sputum examined for diagnosis and appropriate management.

Non-medical community members include the following persons:

• Shasthya Shebikas or other health volunteers.
• Village doctors
• Cured TB patients as well as patients currently on treatment.
• Other important persons in the community such as religious leaders, opinion leaders, community leaders, political leaders, members of union councils, school teachers and persons who have a close connect with the community at the grassroots level.