The FIDELIS initiative: Innovative strategies for increased case finding

SETTING: Low-income, high tuberculosis (TB) burden countries. OBJECTIVE: To compare case finding of new smear-positive pulmonary TB patients in projects funded to apply innovative approaches. DESIGN: Prospective application of innovative approaches to case finding within routine services to determine the numbers of additional cases detected and the cost per additional case detected, according to the type of approach applied. RESULTS: Between 2003 and 2007, 51 FIDELIS projects were implemented in 18 countries; 273 239 cases were reported, of which 85 267 were additional to the number reported in the previous year. The median cost per additional case was US$103. The interventions employed were: 1) social mobilisation and information, education and communication; 2) engagement of the private sector; 3) innovative approaches for microscopy services; 4) enhanced or semi-active case finding; 5) health systems strengthening; and 6) use of incentives. None of these was significantly more likely to detect additional cases or to have a lower cost per additional case than any of the others. CONCLUSION: While there was a substantial increase in cases detected, at a moderate cost per additional case, we were unable to show that any single intervention had an advantage over the others.