Drop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda: A prospective, multi-center study
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
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.
Methods
We 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.
Description
Keywords
Tuberculosis, Investigation cascade, Public health setting
Citation
Armstrong-Hough M, Turimumahoro P, Meyer AJ, Ochom E, Babirye D, Ayakaka I, et al. (2017) Drop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda: A prospective, multi- center study. PLoS ONE 12(11): e0187145. https:// doi.org/10.1371/journal.pone.0187145