Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach

Ayakaka, Irene; Ackerman, Sara; Ggita, Joseph; Kajubi, Phoebe; Dowdy, David W.; Haberer, Jessica; Fair, Elizabeth; Hopewell, Philip C.; Handley, Margaret A.; Cattamanchi, Adithya; Katamba, Achilles; Davis, J. Lucian

doi:10.1186/s13012-017-0561-4

Cited by 100 publications

(155 citation statements)

References 28 publications

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“…Furthermore, ruling out TB in young children, especially in those <2 years old – the age group at highest risk of developing TB after exposure – involves recognition of warning signs and symptoms by parents and physicians, including the revision of growth charts These are not routinely recorded in TB contact investigation, hampering follow‐up. Training primary care staff on paediatric TB screening and diagnosis, strengthening communication between referral and primary care facilities, and designing forms to facilitate the appropriate recording and follow‐up of contacts may increase TB detection in and provision of preventive treatment to eligible contacts …”

Section: Discussionmentioning

confidence: 99%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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Objective Contacts of pulmonary tuberculosis (TB) cases are at high risk of TB infection and progression to disease. Close and household contacts and those <5 years old have the highest risk. Isoniazid preventive therapy (IPT) can largely prevent TB disease among infected individuals. International and Peruvian recommendations include TB contact investigation and IPT prescription to eligible contacts. We conducted a study in Lima, Peru, to determine the number of close and household contacts who were evaluated, started on IPT, and who completed it, and the factors associated to compliance with national guidelines. Methods We conducted a longitudinal retrospective study including all TB cases diagnosed between January 2015 and July 2016 in 13 health facilities in south Lima. Treatment cards, TB registers and clinical files were reviewed and data on index cases (sex, age, smear status, TB treatment outcome), contact investigation (sex, age, kinship to the index case, evaluations at month 0, 2 and 6) and health facility (number of TB cases notified per year, proportion of TB cases with treatment success) were extracted. We tabulated frequencies of contact evaluation by contact and index case characteristics. To investigate determinants of IPT initiation and completion, we used generalised linear mixed models. Results A total of 2323 contacts were reported by 662 index cases; the median number of contacts per case was four (IQR, 2–5). Evaluation at month 0 was completed by 99.2% (255/257) of contacts <5 and 98.1% (558/569) of contacts aged 5–19 years. Of 191 eligible contacts <5 years old, 70.2% (134) started IPT and 31.4% (42) completed it. Of 395 contacts 5–19 years old, 36.7% (145) started IPT and 32.4% (47) completed it. Factors associated to not starting IPT among contacts <5 years old were being a second‐degree relative to the index case (OR 6.6 95CI% 2.6–16.5), not having received a tuberculin skin test (TST) (OR 3.9 95%CI 1.4–10.8), being contact of a smear‐negative index case (OR 5.5 95%CI 2.0–15.1) and attending a low‐caseload health facility (OR 2.8 95%CI 1.3–6.2). Factors associated to not starting IPT among 5–19 year‐olds were age (OR 13.7 95%CI 5.9–32.0 for 16‐19 vs. 5–7 years old), being a second‐degree relative (OR 3.0 95%CI 1.6–5.6), not having received a TST (OR 5.4, 95%CI 2.5–11.8), being contact of a male index case (OR 2.1 95CI% 1.2–3.5), with smear‐negative TB (OR 1.9 95%CI 1.0–3.6), and attending a high‐caseload health facility (OR 2.1 95%CI 1.2–3.6). Factors associated to not completing IPT, among contacts who started, were not having received a TST (OR 3.4 95%CI 1.5–7.9 for <5 year‐olds, and OR 4.3 95%CI 1.7–10.8 for those 5–19 years old), being contact of an index case with TB treatment outcome other than success (OR 9.3 95%CI 2.6–33.8 for <5 year‐olds and OR 15.3 95%CI 1.9–125.8 for those 5–19 years old), and, only for those 5–19 years old, attending a health facility with high caseload (OR 3.2 95%CI 1.4–7.7) and a health facility with low proportion of TB cases with treatment succ...

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Section: Discussionmentioning

confidence: 99%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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“…Previously, we identified several barriers to participants completing these steps, including a lack of knowledge about TB and its potential consequences; HIV and TB stigma; mistrust of health workers; and insufficient time and resources. [9,10] In 2013, the Uganda National TB and Leprosy Programme (NTLP) began implementing household TB contact investigation for all index TB patients in the country's capital, Kampala.…”

Section: Introductionmentioning

confidence: 99%

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

Armstrong-Hough

Turimumahoro²,

Meyer

et al. 2017

Preprint

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2 SummarySetting 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. MethodsWe 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.PeerJ Preprints | https://doi.org/10.7287/peerj.preprints.3313v1 | CC BY 4.0 Open Access | rec:

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“…A study conducted in Vietnam reported that contacts and patients' knowledge, attitude, and practices regarding TB influenced continued engagement in the TB investigation process [14]. Another study from Uganda reported that stigma about TB, the constraint on time and space in clinics for counselling, mistrust of health-center staff by patients and contacts, and high travel costs for health staff to conduct contact screening and for contacts to travel to health facilities were barriers to implement TB contact screening [15].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar

Kyaw¹,

Aung²,

Satyanarayana

et al. 2019

TropicalMed

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Screening of household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) is a crucial active TB case-finding intervention. Before 2016, this intervention had not been implemented in Myanmar, a country with a high MDR-TB burden. In 2016, a community-based screening of household contacts of MDR-TB patients using a systematic TB-screening algorithm (symptom screening and chest radiography followed by sputum smear microscopy and Xpert-MTB/RIF assays) was implemented in 33 townships in Myanmar. We assessed the implementation of this intervention, how well the screening algorithm was followed, and the yield of active TB. Data collected between April 2016 and March 2017 were analyzed using logistic and log-binomial regression. Of 620 household contacts of 210 MDR-TB patients enrolled for screening, 620 (100%) underwent TB symptom screening and 505 (81%) underwent chest radiography. Of 240 (39%) symptomatic household contacts, 71 (30%) were not further screened according to the algorithm. Children aged <15 years were less likely to follow the algorithm. Twenty-four contacts were diagnosed with active TB, including two rifampicin- resistant cases (yield of active TB = 3.9%, 95% CI: 2.3%–6.5%). The highest yield was found among children aged <5 years (10.0%, 95% CI: 3.6%–24.7%). Household contact screening should be strengthened, continued, and scaled up for all MDR-TB patients in Myanmar.

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Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach

Cited by 100 publications

References 28 publications

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

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

Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar

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