TABLE 3.

Changes in the SWEEP-TB Daru model of care over time during a continuous quality improvement initiative.

Category	Activity	Initial	Pre-implementation	Month 1: Implementation	Month 2: Implementation	Month 3: Implementation
Screening and diagnosis	Consenting (screening)	Obtain consent before screening. Age of consent = 16 years Group TB education and information session and individual consenting/assent	Written consent in the household Age of consent = 18 years Group TB education and individual information sessions and consenting	Verbal consent was obtained in the household Age of consent = 18 years Group TB education and individual information session and consent/assent Assessment for capacity to consent included	No change	No change
	Symptom screening	Symptom screening at household	No change	No change	No change	No change
	CXR (CAD4TB)	CXR for all participants CAD4TB for ≥10 years CAD4TB score threshold 50	CXR for all participants CAD4TB for ≥10 years CAD4TB score threshold 50	CXR for ≥10 years CXR for <5 if presumptive (symptom positive, SAM), or contact of index patient (DS/DR) CAD4TB for ≥10 years CAD4TB score threshold 40	No change Pregnant participants undergo CXR after the second trimester CAD4TB low, but CXR image abnormal; referred to hospital for further evaluation CAD4TB high but unable to produce sputum, referred to hospital for further evaluation	Order protective shield for pregnant women
	Sputum collection (Xpert Ultra)	Sputum collection at screening site Sputum collection for all participants	Same as initial GA/FNAB referred to hospital for sample collection	No change Sputum collection only for presumptive participants	No change Paediatric referrals for GA, FNAB weekly	No change
	Clinical evaluation	Clinical assessment Review of results (CXR, Xpert Ultra) Assign outcome (TB/no TB) Refer to hospital for active TB treatment initiation	Same as initial Screening result (presumptive/not presumptive)	No change Referrals to hospital for further evaluation (presumptive but unable to produce sputum, recently completed active TB treatment with abnormal CXR)	No change	No change Include severe acute malnutrition (SAM) as presumptive
	Consenting (TST/TPT)	Written consent at the screening site	Same as initial	No change Group information session Individual capacity to consent	Exclusion if previous TB treatment or TPT in the past 12 months	No change
	TST	Eligible: 5–34 years old, <5 contacts of DR-TB index patients, permanent residents of Daru or residing in the next 12 months TST placement after ruling out active TB TST reading within 48–72 h	Same as initial	TST placement before screening outcome, on the first day of screening Others same as initial	TST placement for all participants aged 5–34 years TST reading for missed at 72 h, done up to day 7 from placement Others no change	No change Strengthen referral from routine contact tracing for <5 contacts of DR-TB index patients Strengthen referral to routine TPT for <5 contacts of DS-TB index patients
Treatment	MTB/RR-TB detected	Refer to hospital for active TB treatment	Same as the initial follow-up to confirm treatment initiation	Same as pre-implementation	Same as pre-implementation	Same as pre-implementation
	Presumptive, MTB not detected	Based on clinical evaluation	Refer to hospital for further evaluation	Same as pre-implementation	Same as pre-implementation	Same as pre-implementation
Prevention	TPT	TST-positive initiated on 6HLFx (5–34 years) and 6Lfx (<5 years)	TPT initiation done at the screening site Follow-up clinics at DART sites (community treatment centres)	Follow-up clinics at the screening site	TPT considerations for pregnant participants	Follow-up clinics at DART site Alternative regimen proposed for 6HLfx during TPT stockout was 6H
	BCG	0–34 years who have never been vaccinated	No change	No change	No change	No change

CXR = chest radiography; CAD4TB = computer-aided diagnostics for TB; SAM = severe acute malnutrition; DS-TB = drug-susceptible TB; DR-TB = drug-resistant TB; GA = gastric aspirate; FNAB = fine-needle aspirate biopsy; TST = tuberculin skin test; TPT = TB preventive therapy; MTB = Mycobacterium tuberculosis; RR-TB = rifampicin-resistant TB; 6HLfx = 6 months of isoniazid and levofloxacin; DART = Daru Accelerated Response to TB.