Adapting a mobile TB screening unit to provide integrated screening services and linkage to primary care

Abstract

OBJECTIVE: We adapted a mobile TB screening unit to create an integrated screening program for noncommunicable diseases and TB, using community health worker (CHW) navigators to support linkage to care. We piloted the model in underserved communities of Lima, Peru, evaluating its feasibility, acceptability, and ability to continue supporting TB case detection. DESIGN: The program provided screening for TB, hypertension, diabetes, and depression and was rebranded to avoid TB-associated stigma. CHW navigators were trained to link people to care for all four conditions. Implementation barriers and facilitators were identified from the implementation team’s meeting minutes. RESULTS: During August–December 2023, we screened 1,000 adults, of whom 254 (25%) were referred for evaluation and paired with CHW navigators. Of these, 197 (78%) underwent evaluation at a health center, and 151 (59%) initiated some form of treatment, including 4 for TB. Completion of the linkage cascade was 93% for TB, 81% for hypertension, 71% for diabetes and 69% for depression. Limitations in equipment and staff were implementation barriers, while multiple flexibility-related facilitators were identified. CONCLUSION: The integrated screening program was acceptable and feasible and still identified people with TB. CHW navigators were effective in supporting linkage to primary care services.

Keywords

• community health services
• community health workers
• patient navigation
• mass screening
• tuberculosis