Abstract
BackgroundIn low tuberculosis (TB) incidence countries, contact investigation (CI) requires not missing contacts with TB infection or disease without unnecessarily evaluating non-infected contacts.AimWe assessed whether updated guidelines for the stone-in-the-pond principle and their promotion improved CI practices.MethodsThis retrospective study used surveillance data to compare CI outcomes before (2011–2013) and after (2014–2016) the guideline update and promotion. Using negative binomial regression and logistic regression models, we compared the number of contacts invited for CI per index patient, the number of CI scaled-up according to the stone-in-the-pond principle, the TB and latent TB infection (LTBI) testing coverage, and yield.ResultsPre and post update, 1,703 and 1,489 index patients were reported, 27,187 and 21,056 contacts were eligible for CI, 86% and 89% were tested for TB, and 0.70% and 0.73% were identified with active TB, respectively. Post update, the number of casual contacts invited per index patient decreased statistically significantly (RR = 0.88; 95% CI: 0.79–0.98), TB testing coverage increased (OR = 1.4; 95% CI: 1.2–1.7), and TB yield increased (OR = 2.0; 95% CI: 1.0–3.9). The total LTBI yield increased from 8.8% to 9.8%, with statistically significant increases for casual (OR = 1.2; 95% CI: 1.0–1.5) and community contacts (OR = 2.0; 95% CI: 1.6–3.2). The proportion of CIs appropriately scaled-up to community contacts increased statistically significantly (RR = 1.8; 95% CI: 1.3–2.6).ConclusionThis study shows that promoting evidence-based CI guidelines strengthen the efficiency of CIs without jeopardising effectiveness. These findings support CI is an effective TB elimination intervention.
Highlights
The Netherlands is a low tuberculosis (TB) incidence country with 4.7 new TB patients per 100,000 population; in 2018, 806 patients were notified [1]
In high burden and low resource settings, contact investigation (CI) focusses primarily on TB screening of people living with HIV (PLHIV), children younger than 5 years old [4], and household and close contacts of index patients with sputum smear-positive pulmonary TB or drug-resistant TB (DRTB)
The objective of this study was to determine whether the guideline adaptation in 2013 resulted in more efficient but or more effective CI practices by determining whether there was a decrease in the number of contacts being invited for CI per index patient, an increase in the number of CI scaled-up according to the stone-in-the-pond principle, and an increase in TB and latent TB infection (LTBI) testing coverage while the relative yield of active TB and LTBI remained similar or increased
Summary
The Netherlands is a low tuberculosis (TB) incidence country with 4.7 new TB patients per 100,000 population; in 2018, 806 patients were notified [1]. In low burden and high resource settings such as the Netherlands, CI takes on a broader focus, which includes identifying other exposed contacts, contacts of sputum smear-negative patients and the transmission source of TB patients who are likely to have been recently infected (source or reverse CI) [3,5]. Using negative binomial regression and logistic regression models, we compared the number of contacts invited for CI per index patient, the number of CI scaled-up according to the stone-in-the-pond principle, the TB and latent TB infection (LTBI) testing coverage, and yield. The number of casual contacts invited per index patient decreased statistically significantly (RR = 0.88; 95% CI: 0.79–0.98), TB testing coverage increased (OR = 1.4; 95% CI: 1.2–1.7), and TB yield increased (OR = 2.0; 95% CI: 1.0–3.9). These findings support CI is an effective TB elimination intervention
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