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

Abstract

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.

Household drug-resistant TB contact tracing in Tajikistan

“…A study from Myanmar among household contacts of index patients with RR-TB reported a yield of 10.0% for children aged <5 years. 22 Fox et al. found a similar yield of 10.0% among TB contacts aged <5 years, and Honjepari et al.…”

“…Our overall yield was 0.7%, which is lower than those in the studies we reviewed, which had an average overall yield of 2.50 (range 0.96–6.50). 7 , 18 – 20 , 22 – 27 DR-TB studies reported overall yields of 3.1%, 3.9% and 6.5%, 20 , 22 , 23 and yields of 1.4% and 3.4% were reported in DR-TB subgroups within larger TB cohorts. 19 , 25 The NNS is the reciprocal of the overall yield.…”

Special Issue “Innovation and Evidence for Achieving TB Elimination in the Asia-Pacific Region”

“…Kyaw et al reported a yield of active TB of 3.9% among HHCs of MDR-TB index patients, with the highest yield of 10% among children under 5 years old. However, only a minority of TB patients diagnosed had rifampicin resistant (RR) TB [ 12 , 13 ]. Finally, Paryani et al reported an incidence rate of TB of 2072/100,000 person years in the HHCs of index patients with pre-extensively drug resistant (pre-XDR) and XDR-TB following initial screening, which shows the importance of ongoing follow up and preventive treatment among HHCs [ 14 ].…”