In most countries, tuberculosis (TB) case finding is passive, relying on symptomatic patients to seek health care on their own initiative. The primary objective of active case finding (ACF) is to identify all active cases of TB within a geographic location. Early detection of active TB can reduce morbidity, mortality, and transmission in a population. The goal of this project is to determine whether TB active case finding (ACF) in conjunction with a Directly Observed Therapy, Short course (DOTS) results in lower incidence of TB compared to routine DOTS alone. This community randomized trial will be conducted in 20 Rio de Janeiro communities within two planning areas (AP) with high rates of TB where community health workers and health units are undergoing intensive training to implement DOTS programs. This will be a collaborative effort between the Municipal Health Secretariat of Rio de Janeiro and the Johns Hopkins University Center for Tuberculosis Research. We will conduct a clustered randomized trial to compare the impact of two case detection and treatment strategies on the community incidence of TB. The 20 communities within 2 APs will be randomized to routine DOTS based on passive case detection or DOTS plus door-to-door active case finding (DOTS-ACF), where TB cases are actively detected by community outreach. These 20 communities will utilize community health workers who routinely collect health information in these communities. We hypothesize that the average TB incidence in years 3, 4 and 5 will be 40% less in the DOTS-ACF arm compared to the DOTS arm and that treatment completion rates will not differ between the two arms of the study.
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