BACKGROUND: Although household contacts of persons with tuberculosis (TB) have high rates of active TB, contact investigations are often not conducted. We present the results from a large-scale active contact investigation combined with treatment support in Sindh, Pakistan. METHODS: Trained lay workers visited consenting smear-positive index patient homes in seven urban and 15 rural facilities. People with suspected TB were provided free transport to diagnostic centres, and sputum samples were collected for microscopy. Those diagnosed with smear-positive TB were given food baskets and sent text reminders to promote adherence. RESULTS: From 3037 index cases, 19,191 household contacts were screened for TB symptoms and 3478 (18.1%) symptomatic persons were identified. Of these, 2160 (62.1%) produced sputum samples on the spot for testing and 490 (22.7%) had smear-positive results. TB prevalence in urban households was 1504 per 100,000 population compared to 4044/100,000 in rural households (P < 0.001) and 2553/100,000 overall. Treatment success was high, with 80.4% cured and 17.6% completing treatment. DISCUSSION: Lay workers given basic training can conduct active contact investigations and provide treatment support to improve case detection and treatment outcomes in urban and rural areas of Pakistan. In areas with high levels of undiagnosed TB, particularly in rural areas, contact investigation should be prioritised as a means of improving case detection and early diagnosis.
BACKGROUND: Although household contacts of persons with tuberculosis (TB) have high rates of active TB, contact investigations are often not conducted. We present the results from a large-scale active contact investigation combined with treatment support in Sindh, Pakistan. METHODS: Trained lay workers visited consenting smear-positive index patient homes in seven urban and 15 rural facilities. People with suspected TB were provided free transport to diagnostic centres, and sputum samples were collected for microscopy. Those diagnosed with smear-positive TB were given food baskets and sent text reminders to promote adherence. RESULTS: From 3037 index cases, 19,191 household contacts were screened for TB symptoms and 3478 (18.1%) symptomatic persons were identified. Of these, 2160 (62.1%) produced sputum samples on the spot for testing and 490 (22.7%) had smear-positive results. TB prevalence in urban households was 1504 per 100,000 population compared to 4044/100,000 in rural households (P < 0.001) and 2553/100,000 overall. Treatment success was high, with 80.4% cured and 17.6% completing treatment. DISCUSSION: Lay workers given basic training can conduct active contact investigations and provide treatment support to improve case detection and treatment outcomes in urban and rural areas of Pakistan. In areas with high levels of undiagnosed TB, particularly in rural areas, contact investigation should be prioritised as a means of improving case detection and early diagnosis.
Authors: M Armstrong-Hough; J Ggita; P Turimumahoro; A J Meyer; E Ochom; D Dowdy; A Cattamanchi; A Katamba; J L Davis Journal: Int J Tuberc Lung Dis Date: 2018-10-01 Impact factor: 2.373
Authors: S Swindells; A Gupta; S Kim; M D Hughes; J Sanchez; V Mave; R Dawson; N Kumarasamy; K Comins; B Smith; R Rustomjee; L Naini; N S Shah; A Hesseling; G Churchyard Journal: Int J Tuberc Lung Dis Date: 2018-09-01 Impact factor: 2.373
Authors: Razia Fatima; Ejaz Qadeer; Aashifa Yaqoob; Mahboob Ul Haq; Suman S Majumdar; Hemant D Shewade; Robert Stevens; Jacob Creswell; Nasir Mahmood; Ajay M V Kumar Journal: PLoS One Date: 2016-11-29 Impact factor: 3.240
Authors: Lucie Blok; Jacob Creswell; Robert Stevens; Miranda Brouwer; Oriol Ramis; Olivier Weil; Paul Klatser; Suvanand Sahu; Mirjam I Bakker Journal: Int Health Date: 2014-08-06 Impact factor: 2.473