Pulmonary tuberculosis case detection through fortuitous cough screening during home visits.

OBJECTIVE To compare the yield of active tuberculosis (TB) case detection among risk groups during home visits with passive detection among patients at health services. METHODS In April 2004, in a first phase, we introduced, active screening for coughing among all family members of patients that were visited at home by their family doctor or nurse for other reasons. Subsequently, from October 2004 onwards, active screening was restricted to family members belonging to groups at risk of TB. RESULTS The overall detection rate of TB increased from 6.7/100,000 during passive detection at health services before the intervention to 26.2/100,000 inhabitants when passive detection was complemented by active case finding. Active screening among risk groups yielded 35 TB cases per 1000 persons screened compared to 20 TB cases per 1000 persons passively screened at health services. Active case finding was particularly efficient in those coughing for 3 weeks or more (107/1000 screened). CONCLUSION This study demonstrates that active case finding in groups at risk during home visits increases the case detection rate in the population and permits the identification of cases that may not be detected through passive case finding at health facility level.