From Case Finding to Continuity: Where HIV and TB Programmes Lose People

Finding an infection is one of the most visible successes in an infectious-disease programme. A person tests positive for HIV, an index tuberculosis case is diagnosed, or a household contact is identified. Yet the public-health benefit depends on what happens next. Detection without confirmation, linkage, treatment, prevention or follow-up can create a programme that counts cases more successfully than it changes outcomes.

DETEC-TB makes this implementation problem concrete. An index case leads to a contact network; contacts must be found, assessed and classified; people with disease or infection must then enter treatment or prevention. Every transition is a possible loss. HIV programmes have learned the same lesson through testing strategies: expanding diagnosis is valuable, but linkage improves when programmes add active facilitation, case management, tracing or streamlined entry into care.

The shared principle is continuity. Case finding should be evaluated as a pathway rather than as a yield statistic. That means measuring not only how many people are identified, but how many complete the next appropriate action and where the chain breaks.