Abstract
BackgroundAppropriate management of people exposed in the home to tuberculosis is essential to prevent morbidity. These household contacts, particularly children, should receive preventive therapy to prevent them from falling ill. However, few people receive preventive therapy worldwide. We sought to determine whether a community-based accompaniment intervention could improve tuberculosis contact management.MethodsWe conducted a prospective cohort study of household contacts of tuberculosis patients who initiated treatment during September 2015-June 2016 in Lima, Peru. Enrolled households received an intervention comprising home visits, transport vouchers, assistance coordinating evaluation procedures, and adherence support during preventive therapy. To evaluate the impact of the intervention, we conducted retrospective chart reviews of all patients initiating treatment during 6-month baseline and intervention periods.ResultsWe enrolled 314 household contacts of 109 index patients. Of these, 283 (90%) completed evaluation, and 4 (1%) were diagnosed with tuberculosis. Preventive therapy was prescribed for 35/38 (92%) contacts 0–19 years old who were eligible under Peruvian guidelines. Preventive therapy was also prescribed for 6/26 (23%) contacts with unknown eligibility due to lack of a tuberculin skin test (TST), and 20/69 (29%) who were ineligible either because of a negative TST result or exposure to a drug-resistant or extrapulmonary case. Of the 61 contacts who were prescribed preventive therapy, 57 (93%) initiated treatment, and 51 (91%) completed treatment. The proportion of contacts who completed evaluation increased from 42% during the baseline period to 71% during the evaluation period (risk ratio [RR] = 1.73, 95% confidence interval [95% CI]: 1.41–2.13). The proportion of contacts who initiated preventive therapy increased from 15% to 40% (RR = 2.45, 95% CI: 1.42–4.22).ConclusionAccompaniment of TB patient households greatly improved the evaluation of household contacts for TB and increased the use of preventive therapy.
Highlights
Accompaniment of TB patient households greatly improved the evaluation of household contacts for TB and increased the use of preventive therapy
People living in the household of a tuberculosis (TB) patient are at high risk of getting infected with Mycobacterium tuberculosis and developing TB disease, especially young children and people with immune-compromising conditions [1]
In low- and middle-income countries, around 2–5% of household members of TB patients are typically diagnosed with TB disease, with children and people living with HIV at high risk [1]
Summary
People living in the household of a tuberculosis (TB) patient are at high risk of getting infected with Mycobacterium tuberculosis and developing TB disease, especially young children and people with immune-compromising conditions [1]. In low- and middle-income countries, around 2–5% of household members of TB patients are typically diagnosed with TB disease, with children and people living with HIV at high risk [1]. Even fewer adult contacts are likely to have received preventive therapy given that HIV-negative adults are not eligible for treatment under most national policies [3]. Appropriate management of people exposed in the home to tuberculosis is essential to prevent morbidity. These household contacts, children, should receive preventive therapy to prevent them from falling ill. We sought to determine whether a community-based accompaniment intervention could improve tuberculosis contact management
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