***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background One of the main strategies to control tuberculosis ( TB ) is to find and treat people with active disease . Unfortunately , the case detection rates remain low in many countries . Thus , we need interventions to find and treat sufficient number of patients to control TB . We investigated whether involving health extension workers ( HEWs : trained community health workers ) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia . Methodology /Principal Finding We carried out a community-r and omized trial in southern Ethiopia from September 2006 to April 2008 . Fifty-one kebeles ( with a total population of 296 , 811 ) were r and omly allocated to intervention and control groups . We trained HEWs in the intervention kebeles on how to identify suspects , collect sputum , and provide directly observed treatment . The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more duration to attend the health posts . Two hundred and thirty smear-positive patients were identified from the intervention and 88 patients from the control kebeles . The mean case detection rate was higher in the intervention than in the control kebeles ( 122.2 % vs 69.4 % , p<0.001 ) . In addition , more females patients were identified in the intervention kebeles ( 149.0 vs 91.6 , p<0.001 ) . The mean treatment success rate was higher in the intervention than in the control kebeles ( 89.3 % vs 83.1 % , p = 0.012 ) and more for females patients ( 89.8 % vs 81.3 % , p = 0.05 ) . Conclusions / Significance The involvement of HEWs in sputum collection and treatment improved smear-positive case detection and treatment success rate , possibly because of an improved service access . This could be applied in setting s with low health service coverage and a shortage of health workers . Trial Registration Clinical Trials.gov BACKGROUND Despite a well-functioning adult tuberculosis ( TB ) control programme , children with TB remain grossly under-detected in Bangladesh . It is conservatively estimated that annually around 21,000 children with TB go undetected , due to an almost exclusive focus on sputum smear-positive TB and the absence of training or guidelines in paediatric TB . OBJECTIVE To double child TB detection by increasing general awareness and training of health care workers at microscopy centres supported by the Damien Foundation ( DF ) Bangladesh . METHODS A cluster-r and omised trial was carried out with provision of child TB guidelines , training and logistics support to staff of 18 microscopy centres , while 18 non-adjacent microscopy centres  continued their  usual practice and served as controls .  Paediatric data on TB suspect referral and case detection were collected at baseline and during the intervention at both control and intervention sites . RESULTS Child TB case detection increased in both intervention and control microscopy centres , but the increase was three times the baseline in the intervention centres ( from 3.8 % to 12 % ) in comparison to less than double the baseline in the control centres ( from 4.3 % to 7 % , P = 0.001 ) . CONCLUSION Simple guidelines and training on child TB case detection , together with basic logistics support , can be integrated into the existing National TB Control Programme and improve service delivery to children in TB-endemic areas OBJECTIVE To assess an active case-finding strategy for the identification of  smear-positive pulmonary tuberculosis ( TB ) in a rural district of Amhara Region , Ethiopia . METHODS Study kebeles ( smallest administrative units ) were r and omly selected in a cross-sectional study . House-to-house visits involving individuals aged > or=15 years in all households of the kebeles were conducted . The heads of households were asked to identify subjects with TB symptoms . Identified suspects were asked to provide three sputum sample s for smear microscopy . RESULTS Among the 47,478 individuals living in households that were screened , 1006 TB suspects and 38 cases were detected . This result ed in 38 cases of smear-positive TB , i.e. , 80 per 100,000 population , using cluster sampling . The ratio of active vs. passive case detection was 2.5:1 , indicating 2.5 undetected TB cases in the community for every smear-positive TB case receiving treatment during the survey period . A higher proportion of female patients was detected by the survey . CONCLUSION The study revealed a very high proportion of undiagnosed TB . This indicates that the potential for a large infectious pool and significant transmission of TB in the community is high . The expansion of diagnostic facilities and the active involvement of health extension workers is necessary to expedite early detection , timely referral and treatment of TB Background : Active tuberculosis ( TB ) screening outside clinics and in communities may reduce undiagnosed TB . Methods : To determine the yield of TB screening during community-based HIV testing campaigns ( CHC ) in 7 rural Ug and an communities within an ongoing cluster-r and omized trial of universal HIV testing and treatment ( SEARCH , NCT:01864603 ) , we offered sputum microscopy to participants with prolonged cough ( > 2 weeks ) . We determined the number of persons needed to screen to identify one TB case , and the number of cases identified that linked to clinic and completed TB treatment . Results : Of 36,785 adults enumerated in 7 communities , 27,214 ( 74 % ) attended CHCs , and HIV testing uptake was > 99 % , with 941 ( 3.5 % ) HIV-infected adults identified . Five thous and seven hundred eighty-six adults ( 21 % ) reported cough and 2876 ( 11 % ) reported cough > 2 weeks . Staff obtained sputum in 1099/2876 ( 38 % ) participants with prolonged cough and identified 10 adults with AFB-positive sputum ; 9 new diagnoses and 1 known case already under treatment . The number needed to screen to identify one new TB case was 3024 adults overall : 320 adults with prolonged cough and 80 HIV-infected adults with prolonged cough . All 9 newly diagnosed AFB+ participants were linked to TB care within 2 weeks and were initiated TB treatment . Conclusions : In a rural Ug and an setting , TB screening as an adjunct to large-scale mobile HIV testing campaigns provides an opportunity to increase TB case detection SETTING Harare 's high density suburbs . OBJECTIVES To investigate the burden , duration and risk factors for prevalent  tuberculosis ( TB ) and explore potential control strategies . METHODS R and omly selected adults had TB culture , symptom screen and human immunodeficiency virus ( HIV ) serology . Prevalent TB was defined as undiagnosed or still culture-positive . Notification data and HIV prevalence in TB out- patients were used to estimate duration of infectiousness ( prevalence/estimated incidence ) . RESULTS Among 10 092 participants , 40 ( 0.40 % , 95%CI 0.28 - 0.54 ) had prevalent smear-positive TB . HIV ( adjusted odds ratio [ aOR ] 3.1 , 95%CI 1.6 - 6.3 , population attributable fraction [ PAF ] 33 % ) , male sex ( aOR 3.1 , 95%CI 1.5 - 6.4 , PAF 40 % ) , and overcrowding ( PAF 34 % ) were significant risk factors , with past TB treatment significant for HIV-negative participants only ( PAF 7 % ) . Recent household TB contact was not significant ( PAF 10 % ) . HIV prevalence was 21.1 % ; 76.9 % of HIV-positive participants were previously untested . Duration of infectiousness was at least 18 weeks in HIV-positive and approximately 1 year in HIV-negative patients . CONCLUSIONS Overcrowding , male sex and HIV infection were major risk factors for prevalent smear-positive TB . Reducing diagnostic delay may have greater potential to improve the control of prevalent TB than interventions targeted at household contacts , TB treatment outcomes , or TB-HIV interventions under current levels of awareness of HIV status Background The World Health Organization strongly recommends regular screening for tuberculosis ( TB ) in HIV-positive individuals . Objective To compare the outcome of anti-tuberculosis treatment ( ATT ) in HIV-positive adults diagnosed with TB through active case-finding ( ACF ) or passive case-finding ( PCF ) .  Design  Antiretroviral therapy (ART)-naïve adults diagnosed with TB were included from two prospect i ve cohort studies conducted in Ethiopia between September 2010 and March 2013 . The PCF cohort was based at out-patient TB clinics , whereas participants in the ACF cohort were actively screened for TB by bacteriological sputum testing ( smear microscopy , Xpert MTB/RIF assay , and liquid culture ) without pre- selection on the basis of symptoms and signs . Outcomes of ATT were compared between participants in the two cohorts ; characteristics at diagnosis and predictors of adverse outcomes were analysed . Results Among 439 TB/HIV co-infected participants , 307 and 132 belonged to PCF and ACF cohorts , respectively . Compared with the ACF participants , hemoptysis , conjunctival pallor , bedridden status , and low mid upper-arm circumference ( MUAC ) were significantly more common in participants identified through PCF . Sputum smear-positivity rates among pulmonary TB cases were 44.2 % and 21.1 % in the PCF and ACF cohorts , respectively ( p<0.001 ) . Treatment success was ascertained in 247 ( 80.5 % ) of the participants in the PCF cohort and 102 ( 77.2 % ) of the participants in the ACF cohorts ( p=0.223 ) . Low MUAC ( p=0.001 ) independently predicted mortality in the participants in both cohorts . Conclusion Although patients identified through ACF had less advanced TB disease , ATT outcome was similar to the patients identified through PCF . To achieve a better outcome , case management in ACF strategy should be strengthened through enhanced patient-centred counselling and adherence support Background The incidence of tuberculosis has increased among South African gold miners despite comprehensive control programmes , including a radiological screening programme . No data are available as to the optimal frequency of screening . The aim of this study was to compare 6-monthly and 12-monthly radiological screening for active tuberculosis case-finding . Methods Employees of a gold mining company were r and omly assigned to the control arm ( screening at baseline , 12 and 24 months ) or the intervention arm ( additional ‘ intervention ’ radiographs at 6 and 18 months after baseline ) . Study outcomes included proportion of tuberculosis cases detected by screening , proportion smear-positive , extent of disease and mortality . Results 22 634 miners were r and omised . Compared with 12-monthly screening , 6-monthly screening detected more tuberculosis suspects but not more cases , partly due to greater attrition between screening and further investigation after ‘ intervention ’ compared with routine radiographs . Tuberculosis cases detected in the 6-monthly versus the 12-monthly screening arm had less extensive disease ( p=0.05 ) and a lower tuberculosis-specific mortality ( death on tuberculosis treatment ) ( 2.1 and 2.8 per 1000 person-years respectively , HR 0.73 , 95 % CI 0.50 to 1.08 , p=0.1 ) , which was most marked in the first 2 months of treatment ( HR 0.48 , 95 % CI 0.23 to 0.98 , p=0.04 ) when death from tuberculosis is most likely . Discussion In setting s with a high prevalence of HIV and tuberculosis despite st and ard tuberculosis control measures , more frequent case-finding may reduce the extent of disease , tuberculosis mortality and tuberculosis transmission through earlier detection of active tuberculosis cases . To be effective , however , all tuberculosis suspects identified through screening must be investigated for tuberculosis SETTING Farms in the Bol and health district , Western Cape Province , South Africa . OBJECTIVE To evaluate the effect of lay health workers ( LHWs ) on tuberculosis ( TB ) control among permanent farm workers and farm dwellers in an area with particularly high TB prevalence . DESIGN Pragmatic , unblinded cluster r and omised control trial . METHODS This trial measured successful treatment completion rates among new smear-positive ( NSP ) adult TB patients on 106 intervention farms , and compared them with outcomes in patients on 105 control farms . Farms were the unit of r and omisation , and analysis was by intention to treat . RESULTS A total of 164 adult TB patients were recruited into the study , 89 of whom were NSP .  The successful treatment completion rate in NSP adult TB patients was 18.7 % higher ( P = 0.042 , 95%CI 0.9 - 36.4 ) on farms in the intervention group than on farms in the control group . Case finding for adult NSP TB cases was 8 % higher ( P = 0.2671 ) on farms in the intervention group compared to the control group . CONCLUSION Trained LHWs were able to improve the successful TB treatment rate among adult NSP TB patients in a 
    Output:
    
Authors ' conclusions The available evidence demonstrates that when used in appropriate setting s , active case‐finding approaches may result in increase in tuberculosis case detection in the short term .