Evaluation of TB Case Finding through Systematic Contact Investigation, Chhattisgarh, India.

Kshitij Khaparde,Madhav Rao Deshpande,Pawan Jethani,Puneet K Dewan,Patrick K Moonan,Sreenivas A Nair,Srinath Satyanarayana,Shamim Mannan

doi:10.1155/2015/670167

Abstract

Rationale. Contact investigation is an established tool for early case detection of tuberculosis (TB). In India, contact investigation is not often conducted, despite national policy, and the yield of contact investigation is not well described. Objective. To determine the yield of evaluating household contacts of sputum smear-positive TB cases in Rajnandgaon district, Chhattisgarh, India. Methods. Among 14 public health care facilities with sputum smear microscopy services, home visits were conducted to identify household contacts of all registered sputum smear-positive TB cases. We used a standardized protocol to screen for clinical symptoms suggestive of active TB with additional referral for chest radiograph and sputa collection. Results. From December 2010 to May 2011, 1,556 household contacts of 312 sputum smear-positive TB cases were identified, of which 148 (9.5%) were symptomatic. Among these, 109 (73.6%) were evaluated by sputum examination resulting in 11 cases (10.1%) of sputum smear-positive TB and 4 cases (3.6%) of smear-negative TB. Household visits contributed additional 63% TB cases compared to passive case detection alone. Conclusion. A standard procedure for conducting household contact investigation identified additional TB cases in the community and offered an opportunity to initiate isoniazid chemoprophylaxis among children.

Highlights

Contact investigation has been recommended internationally as a promising approach for identifying persons at high risk for developing tuberculosis (TB) and offers an opportunity for early case detection [1, 2]
The Revised National Tuberculosis Control Programme of India (RNTCP) guidelines recommend contact investigation among household contacts of sputum smear-positive TB cases, providing isoniazid chemoprophylaxis for children less than 6 years of age who are in close contact of a sputum smear-positive case and are not diagnosed with TB [5, 6]
Studies have shown that active case finding among household contacts yields substantially more TB cases than passive case detection [7,8,9,10]

Summary

Introduction

Contact investigation has been recommended internationally as a promising approach for identifying persons at high risk for developing tuberculosis (TB) and offers an opportunity for early case detection [1, 2]. In many low-resource, high-TB burden countries, contact investigation is not often conducted despite national policy [3, 4]. The Revised National Tuberculosis Control Programme of India (RNTCP) guidelines recommend contact investigation among household contacts of sputum smear-positive TB cases, providing isoniazid chemoprophylaxis for children less than 6 years of age who are in close contact of a sputum smear-positive case and are not diagnosed with TB [5, 6]. Contact investigations detect as many as 2.3% patients with pulmonary TB amongst close contacts in low-income and middle-income countries [3, 11]. In China, with a similar high-burden of TB in India, the yield for active TB case finding through contact investigation ranged from 0 to 6.9% in household contacts [12, 13]

Methods

Results

Discussion

Conclusion