Evaluation of TB Case Finding through Systematic Contact Investigation, Chhattisgarh, India

Abstract

Rationale. Contact investigation is an established tool for early case detection of tuberculosis (TB). In India, contact investigation is not often conducted, despite national policy, and the yield of contact investigation is not well described. Objective. To determine the yield of evaluating household contacts of sputum smear-positive TB cases in Rajnandgaon district, Chhattisgarh, India. Methods. Among 14 public health care facilities with sputum smear microscopy services, home visits were conducted to identify household contacts of all registered sputum smear-positive TB cases. We used a standardized protocol to screen for clinical symptoms suggestive of active TB with additional referral for chest radiograph and sputa collection. Results. From December 2010 to May 2011, 1,556 household contacts of 312 sputum smear-positive TB cases were identified, of which 148 (9.5%) were symptomatic. Among these, 109 (73.6%) were evaluated by sputum examination resulting in 11 cases (10.1%) of sputum smear-positive TB and 4 cases (3.6%) of smear-negative TB. Household visits contributed additional 63% TB cases compared to passive case detection alone. Conclusion. A standard procedure for conducting household contact investigation identified additional TB cases in the community and offered an opportunity to initiate isoniazid chemoprophylaxis among children.

Identification of subclinical tuberculosis in household contacts. The relevance of tuberculosis exposure scores and contact investigations.

“…Crowding might also decrease the association observed in large-scale studies between smoking and TB disease due to passive smoking. The size of the households in the present study (median of 5) was similar to another HHC study in rural Indian (53). Semi-urban and urban Indian families tend to be smaller (41,54), but congested living is common in both rural and urban areas (41) with 96.8 % of families in the present study living in 1-2 rooms.…”

Identification of incipient tuberculosis in household contacts. The relevance of tuberculosis exposure scores and contact investigations.

“…Crowding might also decrease the association observed in large-scale studies between smoking and TB disease due to passive smoking. The size of the households in the present study (median of 5) was similar to another HHC study in rural Indian(45). Semi-urban and urban Indian families tend to be smaller(38,46) but congested living is common in both rural and urban areas(38) with 96.8 % of families in the present study living in 1-2 rooms.…”

Stakeholder perspectives for optimization of tuberculosis contact investigation in a high-burden setting

“…The minimum requirements for TB-CI information to be reported have been documented [ 3 ]. Standardizing protocols for TB-CI and training HWs to adhere to protocols has been shown to be useful in performing effective CIs and in conducting studies on the effectiveness of TB-CI [ 18 , 19 ]. Moreover, the systematic enquiry in TB-CI as has been described in the literature as both a science and an art, requiring effective interviewing skills [ 18 ].…”