# Programmatic Results of Integrating Systematic TB Screening Across Diverse Outpatient Health System Entry Points in the Democratic Republic of the Congo

## TL;DR

A program in the Democratic Republic of the Congo integrated TB screening into outpatient clinics, finding that women were less likely to be screened, tested, or treated for TB.

## Contribution

The study evaluates the programmatic impact of systematic TB screening across diverse outpatient settings in Kinshasa.

## Key findings

- 639,464 individuals were consulted in outpatient departments, with a median number needed to screen of 22.1.
- Women were less likely than men to be screened, tested, or treated for TB throughout the care cascade.
- General practice and HIV departments had significantly lower numbers needed to screen.

## Abstract

The Democratic Republic of the Congo faces a high tuberculosis (TB) burden. In 2022, 61% of an estimated 402,000 TB cases were reported (World Health Organization Global tuberculosis report). To enhance case detection, the national TB program (NTP) introduced a program quality and efficiency approach (PQE), integrating systematic TB screening into outpatient departments (OPDs). Observational data of the PQE on the TB care cascade (from screening to treatment) across 70 sites in Kinshasa that initiated PQE during the first quarter of 2023 are presented. Data were collected monthly and validated during supervision visits, and disaggregated by sex, healthcare facility type (public, private, or faith-based), facility level (primary or secondary), and OPD within each facility. In 2024, 639,464 individuals were consulted in various OPDs in the participating facilities, 57% of which were female. The median number needed to screen (NNS) was 22.1, with an interquartile range of [9.5–104.3]. There was a significantly lower NNS observed in general practice and human immunodeficiency virus departments. Throughout the TB care cascade, women were less likely than men to be screened, tested, or treated. These findings, to be interpreted within the context of Kinshasa pilot facilities, provide insights to the NTP for developing PQE implementation research aimed at understanding the reasons for these discrepancies and informing NTP scale-up at the national level.