Factors Affecting Continued Participation in Tuberculosis Contact Investigation in a Low-Income, High-Burden Setting.

Michelle May D Goroh,Mohammad Saffree Jeffree,Anna P Ralph,Mohd Yusof Ibrahim,Khamisah Awang Lukman,Timothy William,Fredie Robinson,Naing Oo Tha,Swe Swe,Christel H.A Van Den Boogaard

doi:10.3390/tropicalmed5030124

Abstract

Setting: Outpatient clinics, Kota Kinabalu, Malaysia; January–April 2018. Objectives: To identify barriers to full participation in tuberculosis (TB) contact investigation. Methods: Cross-sectional study of knowledge, perceptions, and behaviours among TB contacts. This study was conducted among contacts who attended an initial clinic visit to explore retention in care. During this first visit, contacts were approached for participation in a questionnaire at a follow-up visit. Contacts who consented but did not subsequently attend were interviewed at home. Associations between questionnaire findings and attendance were tested using logistic regression. Results: Of the total 1436 identified contacts, 800 (56%) attended an initial clinic visit. Of 237 consenting TB contacts, 207 (87%) attended their follow-up appointment. In univariable analyses, the odds of attendance were highest for people notified to attend the TB clinic directly by a health inspector; close relatives of TB patients; non-students; people with higher incomes and smaller households; older individuals; males; and people not perceiving TB as stigmatising. In multivariable analysis, mode of notification to attend and having a close relative with TB remained significant. Conclusions: Health inspectors provide an effective role in TB contact investigation through direct personal communication to encourage the completion of the TB screening process, but this requires further integration with clinical processes, and with workplace and school-based investigations.

Highlights

Tuberculosis (TB) is the commonest infectious cause of death internationally
WHO guidelines strongly recommend that after excluding active TB, high-risk contacts of confirmed pulmonary TB patients be commenced on preventive treatment
Several effective preventive treatment regimens are recommended [3], the most commonly recommended being isoniazid as a daily oral medication for 6 months, which is known as isoniazid preventive therapy (IPT)

Summary

Introduction

Tuberculosis (TB) is the commonest infectious cause of death internationally. Globally, an estimated 10.0 million people fell ill with TB in 2018, which is a number that has been relatively stable in recent years. A key TB prevention activity is contact investigation and management for close contacts of people with infectious TB. This provides an opportunity to detect co-prevalent active TB among contacts and allows people with (latent) TB infection to be detected for monitoring or the commencement of treatment to prevent active disease [2]. WHO guidelines strongly recommend that after excluding active TB, high-risk contacts of confirmed pulmonary TB patients be commenced on preventive treatment. Those at highest risk are young children (aged < 5 years) and people of any age with immunosuppression [3]. Contact investigation and management, incorporating TB preventive therapy plus the early detection of active disease, is a highly cost-effective strategy [5]

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Discussion

Conclusion