Estimating the magnitude of pulmonary tuberculosis patients missed by primary health care clinics in South Africa

SETTING:The present study was conducted at 20 randomly selected primary health clinics across Buffalo City Metropolitan Health District, a high TB burden district in South Africa. OBJECTIVE:To estimate the proportion of TB patients missed by primary health clinics. DESIGN:We enrolled 1255 TB-symptomatic individuals exiting primary health clinics between March and December 2015. Participants were interviewed and asked to provide sputum for Xpert® MTB/RIF testing. RESULTS:Clinic staff screened 79.1% of participants seeking care for TB-related symptoms and 21.9% of those attending a clinic for other reasons (P < 0.001). Of those screened by clinic staff, 21.5% reported submitting sputum, although only 9.8% had available results. Study staff tested sputum from 779 participants not tested by clinic staff. Of these, 39 (5.0%) individuals tested positive for TB, three of whom were rifampicin-resistant; 15/39 (38.5%) were never screened and 24/39 (61.5%) were screened but not tested by clinic staff. We estimate that the health system missed 62.9-78.5% of TB patients attending primary health clinics for TB-related symptoms and 89.5-100% of those attending a clinic for other reasons. CONCLUSION:Low rates of TB screening and testing by the health system resulted in missed TB patients. Universal TB screening and testing of symptomatic individuals should be instituted in high TB burden communities in South Africa.