Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial

Lung, Thomas; Marks, Guy B.; Nhung, Nguyen Viet; Anh, Nguyen Thu; Hoa, Nghiem Le Phuong; Anh, Le Thi Ngoc; Hoa, Nguyen Binh; Britton, Warwick J.; Bestrashniy, Jessica; Jan, Stephen; Fox, Gregory J.

doi:10.1016/s2214-109x(18)30520-5

Cited by 33 publications

(28 citation statements)

References 21 publications

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“…Given that unknown history of TB contact was also found as a risk factor of either patient's or doctor's delay, this highlights the benefits of advocating ACF for early diagnosis and early treatment (including preventive therapy), in order to prevent deterioration of the disease. A large randomised controlled trial (RCT) from Vietnam supports that ACF is a cost-effective intervention to increase TB case detection and to reduce all-cause mortality [35,36]. A modelling study also reported that household contact investigations could substantially prevent both TB cases and mortality in children [37].…”

Section: Resultsmentioning

confidence: 99%

Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in the Netherlands

Gafar

Boveneind-Vrubleuskaya

Akkerman

et al. 2019

Eur Respir J

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BackgroundAs a vulnerable population, children and adolescents with tuberculosis (TB) are faced with many challenges, even those who live in low TB incidence countries. We aimed to evaluate factors associated with TB treatment outcomes allowing more focused interventions to support this population once diagnosed.MethodsA retrospective cohort study using a nationwide surveillance database was performed in children and adolescents (aged 0–18 years) treated for TB in the Netherlands from 1993 to 2018. Logistic regression analyses were used to estimate adjusted odds ratios (aOR) for associated factors of mortality and loss to follow-up (LTFU).ResultsAmong 3253 eligible patients with known outcomes, 94.4% (95.9% children and 92.8% adolescents) were cured or completed treatment, 0.7% died during treatment and 4.9% were LTFU. There were no reported treatment failures. Risk factors of death included children aged 2–4 years (aOR 10.42), central nervous system TB (aOR 5.14), miliary TB (aOR 10.25), HIV co-infection (aOR 8.60), re-treated TB cases (aOR 10.12) and drug-induced liver injury (aOR 6.50). Active case-finding was a protective factor of death (aOR 0.13). Risk factors of LTFU were adolescents aged 15–18 years (aOR 1.91), illegal immigrants (aOR 4.28), urban domicile (aOR 1.59), unknown history of TB contact (aOR 1.99), drug-resistant TB (aOR 2.31), single adverse drug reaction (aOR 2.12), multiple adverse drug reactions (aOR 7.84) and treatment interruption >14 days (aOR 6.93). Treatment in recent years (aOR 0.94) and supervision by public health nurses (aOR 0.14) were protective factors of LTFU.ConclusionHighly successful treatment outcomes were demonstrated in children and adolescents routinely treated for TB. Special attention should be given to specific risk groups to improve treatment outcomes.

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Section: Resultsmentioning

confidence: 99%

Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in the Netherlands

Gafar

Boveneind-Vrubleuskaya

Akkerman

et al. 2019

Eur Respir J

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“…The evidence for the best approach to increase TB case detection is incomplete [18], however, active case-finding has been identified as one such approach that has been successful [19]. A study in Vietnam, for instance, has highlighted the value of household contact tracing and investigation [20,21]. Other countries, such as India focuses on systematic screening in high-risk populations such as people living in urban slums [22].…”

Section: Plos Onementioning

confidence: 99%

Trends of tuberculosis case detection, mortality and co-infection with HIV in Ghana: A retrospective cohort study

2020

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Background In an era of renewed commitment to accelerate the declines in Tuberculosis (TB) incidence and mortality, there is the need for National Tuberculosis Programmes (NTPs) to monitor trends in key indicators across a geographical location and to provide reliable data for direct measurement of TB incidence and mortality. In this context, we explored the trends of TB case detection, mortality and HIV co-infection, and examined the predictors of TB deaths in Ten districts of the Volta region of Ghana. Methods We conducted a retrospective cohort study of all TB cases registered from 2013 to 2017 in 10 districts of the Volta Region of Ghana. Case detection rate (CDR) was computed as the ratio of the number of new and relapse TB case notified to NTP to the number of estimated incident TB cases in a given year. Case fatality rates were estimated using data from 2012-2016 cohort of TB patients. Simple and multiple logistic regression were used to identify predictors of TB deaths with odds ratios and 95% confidence intervals estimated. Results Overall, there were 3,735 new and relapse TB patients who commenced anti-TB treatment during the period, representing the case detection rate of 40.1% with district variations. The CDR remained stable during the 5 years. Of the total cases, HIV status was documented for 3,144 (84.2%), among whom, 712 (22.6%) were HIV positive. The TB/HIV co-infection was more prevalent among children under 15 years of age (30.1%), males (30.6%), treatment after lost to follow-up patients (33.3%), and smear-negative pulmonary TB patients (29.1%). The prevalence of TB/HIV co-infection did not significantly change over the years. The overall case fatality rate was 13% (n = 486), with considerable variation among HIV-positives and HIV-negative TB patients (21.8% and 11% respectively) (p<0.001) and among districts.

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“…Intensive household contact tracing was also found to reduce all-cause mortality in the intervention districts from 1.7% (control districts) to 0.6% (intervention districts; relative risk: 0.60; 95% CI : 0.50–0.80; P < 0.001) [6]. The analysis found that household contact tracing is a highly cost-effective intervention when compared with PCF alone (USD 544 per disability-adjusted life year averted) [7].…”

Section: Introductionmentioning

confidence: 99%

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

Gurung¹,

Dixit²,

Rai³

et al. 2019

Infect Dis Poverty

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BackgroundThe World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.MethodsThe study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.ResultsNinety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P < 0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant.ConclusionsACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.

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Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial

Cited by 33 publications

References 21 publications

Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in the Netherlands

Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in the Netherlands

Trends of tuberculosis case detection, mortality and co-infection with HIV in Ghana: A retrospective cohort study

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

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