Objective To investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic
of the Congo, especially among groups at high risk of tuberculosis infection.
Methods To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselves
received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received
training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged
cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the
intervention (2014–2016).
Findings Acceptability of the intervention was high. Volunteers screened 650434 individuals in their communities, 73418 of whom reported
a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened,
costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with
poorer access to health care represented only 5.1% (33 002/650 434) of those screened, they contributed 19.7% (845/4300) of tuberculosis
diagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis
diagnoses, 42% (4 300/10 247) of the provincial total for that period.
Conclusion Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used
to assist health systems in the elimination of tuberculosis.