Effectiveness of Household Contact Investigation with Preventive Therapy for Infectious Tuberculosis in an Intermediate Tuberculosis Burden Country: A Nationwide Investigation

2021 ◽  
Author(s):  
Sun-Young Jung ◽  
Kang-Mo Gu ◽  
Jae-Eun Lee ◽  
Joo-Hyeon Eom ◽  
Kyungeun Lee ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Household Contact ◽  
Contact Investigation ◽  
Household Contact Investigation

scholarly journals Yield of household contact investigation of patients with pulmonary tuberculosis in southern Ethiopia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mubarek A. Yassin ◽  
Kesetebirhan D. Yirdaw ◽  
Daniel G. Datiko ◽  
Luis E. Cuevas ◽  
Mohammed A. Yassin
Keyword(s):  
Pulmonary Tuberculosis ◽  
Household Contact ◽  
Southern Ethiopia ◽  
Contact Investigation ◽  
Household Contact Investigation

scholarly journals Drop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda: A prospective, multi-center study

2017 ◽  
Author(s):  
Mari Armstrong-Hough ◽  
Patricia Turimumahoro ◽  
Amanda Meyer ◽  
Emmanuel Ochom ◽  
Diana Babirye ◽  
...  
Keyword(s):  
At Risk ◽  
Health Workers ◽  
Index Patient ◽  
Household Contact ◽  
Drop Out ◽  
Lay Health Workers ◽  
Contact Investigation ◽  
Multi Center Study ◽  
Public Health Setting ◽  
Household Contact Investigation

Setting Seven public tuberculosis (TB) units in Kampala, Uganda, where Uganda’s national TB program recently introduced household contact investigation, as recommended by 2012 guidelines from WHO. Objective To apply a cascade analysis to implementation of household contact investigation in a programmatic setting. Design Prospective, multi-center observational study. Methods We constructed a cascade for household contact investigation to describe the proportions of: 1) index patient households recruited; 2) index patient households visited; 3) contacts screened for TB; and 4) contacts completing evaluation for, and diagnosed with, active TB. Results 338 (33%) of 1022 consecutive index TB patients were eligible for contact investigation. Lay health workers scheduled home visits for 207 (61%) index patients and completed 104 (50%). Among 287 eligible contacts, they screened 256 (89%) for symptoms or risk factors for TB. 131 (51%) had an indication for further TB evaluation. These included 59 (45%) with symptoms alone, 58 (44%) children <5, and 14 (11%) with HIV. Among 131 contacts found to be symptomatic or at risk, 26 (20%) contacts completed evaluation, including five (19%) diagnosed with and treated for active TB, for an overall yield of 1.7%. The cumulative conditional probability of completing the entire cascade was 5%. Conclusion Major opportunities exist for improving the effectiveness and yield of TB contact investigation by increasing the proportion of index households completing screening visits by lay health workers and the proportion of at-risk contacts completing TB evaluation.

scholarly journals Cost-effectiveness of household contact investigation for detection of tuberculosis in Pakistan

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e049658
Author(s):  
Hamidah Hussain ◽  
Amyn Malik ◽  
Junaid F Ahmed ◽  
Sara Siddiqui ◽  
Farhana Amanullah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Index Patient ◽  
Household Contact ◽  
Household Contacts ◽  
Contact Investigation ◽  
Number Of Patients ◽  
The Cost ◽  
The Impact ◽  
Household Contact Investigation

ObjectivesDespite WHO guidelines recommending household contact investigation, and studies showing the impact of active screening, most tuberculosis (TB) programmes in resource-limited settings only carry out passive contact investigation. The cost of such strategies is often cited as barriers to their implementation. However, little data are available for the additional costs required to implement this strategy. We aimed to estimate the cost and cost-effectiveness of active contact investigation as compared with passive contact investigation in urban Pakistan.MethodsWe estimated the cost-effectiveness of ‘enhanced’ (passive with follow-up) and ‘active’ (household visit) contact investigations compared with standard ‘passive’ contact investigation from providers and the programme’s perspective using a simple decision tree. Costs were collected in Pakistan from a TB clinic performing passive contact investigation and from studies of active contact tracing interventions conducted. The effectiveness was based on the number of patients with TB identified among household contacts screened.ResultsThe addition of enhanced contact investigation to the existing passive mode detected 3.8 times more cases of TB per index patient compared with passive contact investigation alone. The incremental cost was US$30 per index patient, which yielded an incremental cost of US$120 per incremental patient identified with TB. The active contact investigation was 1.5 times more effective than enhanced contact investigation with an incremental cost of US$238 per incremental patient with TB identified.ConclusionOur results show that enhanced and active approaches to contact investigation effectively identify additional patients with TB among household contacts at a relatively modest cost. These strategies can be added to the passive contact investigation in a high burden setting to find the people with TB who are missed and meet the End TB strategy goals.

Tuberculosis contact investigation and short-course preventive therapy among young children in Africa

2020 ◽  
Vol 24 (4) ◽  
pp. 452-460
Author(s):  
V. Schwoebel ◽  
K. G. Koura ◽  
M. Adjobimey ◽  
S. Gnanou ◽  
A. G. Wandji ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
X Rays ◽  
Resource Limited ◽  
Short Course ◽  
Contact Investigation ◽  
Chest X Ray ◽  
Household Contact Investigation ◽  
Children Under 5

SETTING: The largest cities in Benin, Burkina Faso, Cameroon and Central African Republic.OBJECTIVE: To demonstrate the feasibility and document the effectiveness of household contact investigation and preventive therapy in resource-limited settings.DESIGN: Children under 5 years living at home with adults with bacteriologically confirmed pulmonary tuberculosis (TB) were screened using questionnaire, clinical examination, tuberculin skin test and chest X-ray. Children free of active TB were offered preventive treatment with a 3-month rifampicin-isoniazid (3RH) or 6-month isoniazid (6H) regimen in Benin. Children were followed-up monthly during treatment, then quarterly over 1 year. Costs of transportation, phone contacts and chest X-rays were covered.RESULTS: A total of 1965 children were enrolled, of whom 56 (2.8%) had prevalent TB at inclusion. Among the 1909 children free of TB, 1745 (91%) started preventive therapy, 1642 (94%) of whom completed treatment. Mild adverse reactions, mostly gastrointestinal, were reported in 2% of children. One case of incident TB, possibly due to a late TB infection, was reported after completing the 3RH regimen.CONCLUSION: Contact investigation and preventive therapy were successfully implemented in these resource-limited urban settings in programmatic conditions with few additional resources. The 3RH regimen is a valuable alternative to 6H for preventing TB.

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