Lessons learned from community-based tuberculosis case-finding in western Kenya

Setting: Although Kenya has a high burden of tuberculosis (TB), only 46% of cases were diagnosed in 2016. Objective: To identify strategies for increasing attendance at community-based mobile screening units. Design: We analysed operational data from a cluster-randomised trial, which included community-based mobile screening implemented during February 2015–April 2016. Community health volunteers (CHVs) recruited individuals with symptoms from the community, who were offered testing for human immunodeficiency virus (HIV) and sputum collection for Xpert ® MTB/RIF testing. We compared attendance across different mobile unit sites using Wilcoxon rank-sum test. Results: A total of 1424 adults with symptoms were screened at 25 mobile unit sites. The median total attendance among sites was 54 (range 6–134, interquartile range [IQR] 24–84). The median yields of TB diagnoses and new HIV diagnoses were respectively 2.4% (range 0.0–16.7, IQR 0.0–5.3) and 2.5% (range 0.0–33.3, IQR 1.2–4.2). Attendance at urban sites was variable; attendance at rural sites where CHVs were paid a daily minimum wage was significantly higher than at rural sites where CHVs were paid a nominal monthly stipend ( P < 0.001). Conclusion: Mobile units were most effective and efficient when implemented as a single event with community health workers who are paid a daily wage.