Contact Investigation of Multidrug-Resistant Tuberculosis Patients: A Mixed-Methods Study from Myanmar

Abstract

There is no published evidence on contact investigation among multidrug-resistant tuberculosis (MDR-TB) patients from Myanmar. We describe the cascade of contact investigation conducted in 27 townships of Myanmar from January 2018 to June 2019 and its implementation challenges. This was a mixed-methods study involving quantitative (cohort analysis of programme data) and qualitative components (thematic analysis of interviews of 8 contacts and 13 health care providers). There were 556 MDR-TB patients and 1908 contacts, of whom 1134 (59%) reached the health centres for screening (chest radiography and symptoms). Of the latter, 344 (30%) had presumptive TB and of them, 186 (54%) were investigated (sputum microscopy or Xpert MTB/RIF®). A total of 27 TB patients were diagnosed (six bacteriologically-confirmed including five with rifampicin resistance). The key reasons for not reaching township TB centres included lack of knowledge and lack of risk perception owing to wrong beliefs among contacts, financial constraints related to loss of wages and transportation charges, and inconvenient clinic hours. The reasons for not being investigated included inability to produce sputum, health care providers being unaware of or not agreeing to the investigation protocol, fixed clinic days and times, and charges for investigation. The National Tuberculosis Programme needs to note these findings and take necessary action.

The use of rats to detect drug-resistant TB

“…8 This was similar among contacts of MDR-TB cases according to a recent study in Myanmar where four in 10 contacts did not attend the health facility for screening. 9 Our report suggests that there is a great potential for screening of contacts of MDR-TB patients using cheap (USD1 per sample tested, compared to USD18 using MTB/RIF) rat-based technology, particularly in high-burden MDR-TB settings. 2 However, this warrants further investigation to under-stand the yield, sensitivity and specificity of rat-based assessment.…”

Determinants of losses in the latent tuberculosis infection cascade of care in Brazil

“…5 In a study conducted in Myanmar, of 1908 MDR-TB contacts, some participants refused the contact investigation because they strongly believed that they did not have TB disease given that they did not have any signs or symptoms. 22 Interestingly, the factors associated with loss in the LTBI care cascade are also factors associated with increased TB risk (factors that impair the host's defence against TB infection and disease, such as HIV infection and low SES). 21 LTBI was significantly more common in black/pardo individuals.…”

Determinants of losses in the latent tuberculosis infection cascade of care in Brazil: a prospective multicenter cohort study

“…Two main reasons for this finding have been identified previously: (i) not having interest in being tested and (iii) self-perceived low risk of TB infection [7]. In a study of 1,908 TB contacts, some participants refused the contact investigation because they strongly believed that they did not have TB disease given that they did not have any signs or symptoms [16].…”