An evaluation of ‘Ribolola’: a household tuberculosis contact tracing programme in North West Province, South Africa

Thind, D; Charalambous, Salome; Tongman, A; Churchyard, Gavin J.; Ad, Grant

doi:10.5588/ijtld.12.0074

Cited by 26 publications

(21 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also observed poor performance of sputum fluorescence microscopy to identify TB disease: only 1 of 35 TB cases was positive by smear microscopy. Poor performance of smear microscopy has also been reported from other ICF programs [29], [30].…”

Section: Discussionmentioning

confidence: 52%

High Prevalence of Pulmonary Tuberculosis but Low Sensitivity of Symptom Screening among HIV-Infected Pregnant Women in South Africa

et al. 2013

View full text Add to dashboard Cite

Symptom screening is a recommended component of intensified case-finding (ICF) for pulmonary tuberculosis (TB) among HIV-infected individuals. Symptomatic individuals are further investigated to either exclude or diagnose pulmonary TB, thus reducing the number of individuals requiring costly laboratory investigation. Those with laboratory evaluations negative for pulmonary TB or who lack symptoms may be eligible for antiretroviral therapy (ART) and/or TB isoniazid preventive therapy (IPT). A four-part symptom screen has been recommended by the World Health Organization (WHO) for identifying TB suspects and those unlikely to have TB. A meta-analysis of studies among HIV-infected individuals calculated a sensitivity of 90.1% for the four-part symptoms screen - of any of cough, fever, night sweats, or weight loss - among patients in clinical care, making it an effective tool for identifying most patients with TB. An important population for intensified case-finding not included in that meta-analysis was HIV-infected pregnant women. We undertook a cross-sectional survey among HIV-infected pregnant women receiving prenatal care at community clinics in South Africa. We obtained a four-symptom review and sputum smear microscopy and mycobacterial culture on all participants. Among 1415 women, 226 (16%) had a positive symptom screen, and 35 (2.5%) were newly diagnosed with culture-positive TB. Twelve were on TB treatment at the time of screening, yielding 47 (3.3%) women with prevalent TB. Symptom screening among women without known TB had a sensitivity of 28% and specificity of 84%. The poor performance of symptom screening to identify women with TB suggests that other approaches may be needed for intensified case-finding to be effective for this population.

show abstract

Section: Discussionmentioning

confidence: 52%

High Prevalence of Pulmonary Tuberculosis but Low Sensitivity of Symptom Screening among HIV-Infected Pregnant Women in South Africa

et al. 2013

View full text Add to dashboard Cite

show abstract

“…6 The low proportion of contacts from whom we were able to collect a sputum sample and our deliberately pragmatic design may, in part, explain the lower yield in our study compared to two other South African studies. We used lay health workers instead of nurses, 6 made only one household visit attempt instead of up to three, 6,16 collected a single spontaneous sputum rather than one spot and two early morning sputum samples 16 or induced sputum, 6 and did not perform culture. 6,16 …”

Section: Discussionmentioning

confidence: 99%

A home tracing program for contacts of people with tuberculosis or HIV and patients lost to care

Deery

Hanrahan

Selibas

et al. 2014

int j tuberc lung dis

View full text Add to dashboard Cite

SUMMARY SETTING Primary care clinic serving a high tuberculosis (TB) and human immunodeficiency virus (HIV) prevalence community in South Africa. OBJECTIVE To evaluate a program combining TB and HIV contact investigation with tracing of individuals lost to TB or HIV care. DESIGN Contacts were offered home-based HIV testing, TB symptom screening, sputum collection and referral for isoniazid preventive therapy (IPT). Effectiveness was assessed by the number needed to trace (NNT). RESULTS Only 419/1197 (35.0%) households were successfully traced. Among 267 contacts, we diagnosed 27 new HIV cases (10 linked to care) and two TB cases (both initiated treatment) and three started IPT. Of 630 patients lost to care, 132 (21.0%) were successfully traced and 81 (61.4%) re-engaged in care. The NNT to locate one individual lost to care was 4.8 (95%CI 4.1–5.6), to re-engage one person in care 7.8 (95%CI 6.4–9.7), to diagnose one contact with HIV 44.3 (95%CI 30.6–67.0), to link one newly diagnosed contact to HIV care 120 (95%CI 65.3–249.2) and to find one contact with active TB and initiate treatment 599 (95%CI 166.0–4940.7). CONCLUSION The effectiveness of this contact tracing approach in identifying new TB and HIV cases was low. Methods to optimize contact investigation should be explored and their cost-effectiveness assessed.

show abstract

“…Other models from the literature have shown much higher yields, although with a signifi cant increase in resources. 6,7 While the enhanced models presented here were not effective at detecting undiagnosed TB cases, there were a number of operational issues that may have impacted on their effectiveness. The lessons learnt and the practical challenges demonstrated are relevant for those working to implement services in similar settings.…”

Section: Discussionmentioning

confidence: 99%

“…5 Two South African studies in which contacts were screened in their homes found a high yield of TB of between 3% and 9%. 6,7 However, these programmes can be costly, and intensive interventions operating in parallel to existing services may not be sustainable. 8 The Stop TB Partnership advises that contact screening should be managed within existing programmes by establishing a 'contact clinic' at the health centre.…”

mentioning

confidence: 99%

Development and testing of models of tuberculosis contact tracing in rural southern Africa

Kliner

Knight

Elston

et al. 2013

public health action

View full text Add to dashboard Cite

a 53% TB case detection rate (World Health Organization target 70%); there is currently no systematic programme for tracing contacts of TB cases for screening. The Swaziland Ministry of Health has identifi ed inadequate investigation of household contacts as one reason why the national TB response is insuffi cient, and it has committed to conducting systematic investigation of contacts.The aim of the present study is to evaluate hospitalbased contact screening and test approaches to improve effectiveness, through community follow-up. METHODS Study settingThe present study was conducted in the TB department of Good Shepherd Hospital (GSH), a regional rural hospital serving a population of 200 000. The hospital provides support to community clinics and outreach services such as trained fi eld offi cers, known as motorcycle adherence offi cers. Study designThis is an evaluation of hospital-based universal TB household contact screening, conducted from November 2011 to October 2012. It includes a quality improvement project evaluating three enhanced models to investigate the effectiveness of community follow-up. Study populationAll household contacts of index patients were included in the study. An index patient was defi ned as any patient aged >5 years with pulmonary TB or <5 years with any form of TB. A household contact was defi ned as someone living under the same roof as an index case at the time of, or within 3 months of, diagnosis. InterventionNewly diagnosed index patients providing consent for contact tracing were asked to list their household contacts. The standard (hospital-based) model for TB contact tracing was as follows: 1) all contacts attending the TB clinic with the index patient at any appointment were offered TB screening, and 2) a letter was given to the index patient to invite household contacts for screening at the hospital.Adult contacts were screened by clinical assessment using the Swaziland TB screening tool (Table 1). 9 In high HIV prevalence settings, symptom-based screening tools are sensitive in adults (84%), although not very specifi c (60%). 12 Contacts aged <5 years were screened by the paediatrician, and investigated using chest X-ray Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor VOL 3 NO 4 PUBLISHED 21 DECEMBER 2013http://dx.doi.org/10.5588/pha.13.0070Setting: A regional hospital in rural Swaziland. Objectives: To evaluate a hospital-based contact screening programme and test approaches to improve its effectiveness. Design: An evaluation and quality improvement study of tuberculosis (TB) contact tracing services. Results: Hospital-based TB contact tracing led to screening of 157 (24%) of 658 contacts; of these, 4 (2.5%) were diagnosed with TB. Of 68 contacts eligible for human immunodeficiency virus (HIV) testing and counselling, 45 (66%) were tested and 7/45 (16%) were identified as HIV-positive. Twelve (50%) of 24 screened contacts aged <5 years were provided isoniazid prophylaxis. Three enhanced models of TB contact tracing were piloted to...

show abstract

An evaluation of ‘Ribolola’: a household tuberculosis contact tracing programme in North West Province, South Africa

Cited by 26 publications

References 9 publications

High Prevalence of Pulmonary Tuberculosis but Low Sensitivity of Symptom Screening among HIV-Infected Pregnant Women in South Africa

High Prevalence of Pulmonary Tuberculosis but Low Sensitivity of Symptom Screening among HIV-Infected Pregnant Women in South Africa

A home tracing program for contacts of people with tuberculosis or HIV and patients lost to care

Development and testing of models of tuberculosis contact tracing in rural southern Africa

Contact Info

Product

Resources

About