TUBIDU III International Training in Bucharest,

Romania
27th 28th of February 2014

Tuberculosis and
Early Case Finding
Piloting of TUBIDU Handbook

27-28.02.2014

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Module 2 - TB case
finding among
Module Goal
PWID
Give an overview of active and passive TB case
finding
Give an overview of methods and means that are
commonly used for TB case finding among PWID
Topics covered
Topic 2.1 - TB case finding methods among PWID
Topic 2.2 - Referral of clients with presumptive TB to
TB clinics or other healthcare facilities

27-28.02.2014

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Module 2 - TB case
finding among
PWID
TB case finding
methods
among PWID

27-28.02.2014

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Intensified TB case
finding among PWID
Screening for any signs or symptoms of active TB
disease.
Aims to identify the persons who are at high risk of
getting infected with TB or developing TB disease.
Early detection and treatment - prevents severe
forms of TB disease and increases the rate of
successful treatment and decrease TB transmission.

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Challenges
PWID are not welling to come and engage with TB
screening efforts due several reasons (stigma, fear of
police, lack of time);
Usually PWID have other psycho-social problems
(should be aware of that treating on the same time
TB and the other problems);
Working with PWID need very good communication
skills and knowledge about TB and drug addiction;
Diagnosis, regular surveillance of treatment and
prevention activities among PWID requires extra effort
by medical service providers and CBO personnel (e.g.
active referral to healthcare facilities for further
testing, DOT, outreach work etc.).
27-28.02.2014

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BUT
Early diagnosis and complete
treatment of TB among PWID is an
essential public health intervention
that requires sustained political
commitment and efficiently
coordinated action between health
services and CBOs.

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Active case finding AIMS

To identify signs and symptoms of TB disease at
the earliest possible stage among individuals who
are at high risk and not yet seeking medical
attention.
To reduce transmission of TB in the community in
order to increase the chances of survival when once
diagnosed with TB.

27-28.02.2014

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Approaches
Outreach work
Integrating active case finding into harm
reduction activities
Use a questionnaire for all new clients
Screened annually

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How to deal with difficult

and challenging
behaviour?
All the time should verify whether the client is
under the influence of drugs, as it can be more
difficult to manage intoxicated clients.
If a client is intoxicated (drugs, alcohol) is more
possible to be aggressive, disobedient and/or
delirious, and in this situation he/she can have
severe difficulties to understand what the CBO
personnel want to tell him/her.
MOST IMPORTANT: debrief to someone within the CBO
after the incident
27-28.02.2014

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Module 2 - TB case finding

among
PWID

Referral of clients with

presumptive TB to
TB clinics
or other healthcare
facilities
27-28.02.2014

www.tai.ee/en/tubidu

Referrals of clients to TB
clinics (1)
Active case finding can be effective only with an
efficient referral system between CBOs and nearest
TB clinics
If you suspect that a client has active TB it is
important to refer him/her immediately to a TB clinic
or other healthcare service for specialized control
and for confirmation or nor of TB diagnosis.
It is important to have an agreed referral system
(map) between your CBOs and TB clinics to be sure
that the person will have a diagnosis a.s.a.p. And
he/she will start immediately a specialized
treatment.
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Referrals of clients to TB
clinics (2)
We have to keep in mind the fact that TB diagnosis
need time and can involve more procedures and
several visits to the healthcare facility.

All the time, if is possible, an CBO worker or

someone from the TB clinic should accompanied the
client to the clinic and monitoring him/her during
the diagnosis and treatment process to ensure that
the client will not get discouraged or lost on the
way.

27-28.02.2014

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Referrals of clients to TB
clinics (3)

If a client needs to be referred to a TB

clinic:

Inform the healthcare service about a the TB

case that you will send to them.
Dont let the client to go by himself to the TB
clinic, provide transportation and support him/her
throughout diagnostic procedures.
If you cant go with the client be sure that he/she
receive
information on how to reach the clinic, and if is
possible cover
the travel costs.
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Referrals of clients to TB
clinics (4)

If we dont go with him/her is more likely that the

client will not go to screen for TB due to several

reasons ( lack of motivation, postponement, change
of plans).
To reduce the risk of not reaching the TB facilities
make sure that the client understands the
importance of going for TB investigations and try to
make the transferral process as simple as possible.
If the client fails at the first time to attend the TB
service, next time consider an accompanied referral.
Dont forget that TB combined with DU can be
more stigmatised and marginalized than other
diseases.
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