Yield of tuberculosis among household contacts of tuberculosis patients in Accra, Ghana

Sally-Ann Ohene,Nii Nortey Hanson-Nortey,Samuel Danso,Adelaide Sackey,Paul Klatser,Felix Afutu,Frank Bonsu,Mirjam Bakker

doi:10.1186/s40249-018-0396-5

Abstract

BackgroundThe End TB Strategy calls for systematic screening of selected high-risk groups including contacts of tuberculosis (TB) cases to facilitate early TB case detection. Contact investigation is not usually routinely practiced in low TB burden countries, such as Ghana, with consequent paucity of data on the yield of TB case detection from such interventions. This study’s objective was to document the outcomes and feasibility of implementing contact investigation activities under programmatic conditions in Ghana.MethodsRetrospective analyses were conducted of abstracted data from the National TB Program, following a contact investigation intervention for TB cases diagnosed in 10 facilities in Accra from June 2010 to December 2014. Various proportions and yield from number of contacts needed to screen (NNS) and number needed to test (NNT) to detect a TB case were assessed.ResultsOverall, out of the 8519 listed contacts of 3267 index cases, 8166 (96%) were screened and 614 (7.5%) were identified as presumptive TB. Out of these, 438 (71%) underwent sputum smear microscopy/evaluation and 53 TB cases were diagnosed. Of these, 56.6% were males, and 49% had sputum smear-positive TB, 38% had sputum smear-negative TB, and 7% had extra-pulmonary TB. The NNS and NNT to detect a TB case of all forms were 154 and 8, respectively. The proportion of TB cases with contacts listed and proportion of contacts screened annually were 88–96% and 83–100%, respectively. The proportion of presumptive TB cases tested and proportion of TB cases diagnosed among contacts tested that were 100% and 36%, respectively, in 2010 dropped to 40% and 14%, respectively, by 2014.ConclusionsThe study demonstrates that contact identification and prioritization components of a contact investigation were feasible, but overall yield of TB cases may have been lower due to the declining rate of clinical evaluation of presumptive TB contacts over time. Addressing barriers to accessing appropriate diagnostic tests may enhance yield from contact investigation in Ghana.

Highlights

The End TB Strategy calls for systematic screening of selected high-risk groups including contacts of tuberculosis (TB) cases to facilitate early TB case detection
The study demonstrates that contact identification and prioritization components of a contact investigation were feasible, but overall yield of TB cases may have been lower due to the declining rate of clinical evaluation of presumptive TB contacts over time
While other studies have reported higher figures for contacts identified per index TB case, it is worthwhile to note that various definitions of index cases and household contacts may account for the discrepancy of figures reported in different studies [3, 4, 11,12,13]

Summary

Introduction

The End TB Strategy calls for systematic screening of selected high-risk groups including contacts of tuberculosis (TB) cases to facilitate early TB case detection. Contact investigation is not usually routinely practiced in low TB burden countries, such as Ghana, with consequent paucity of data on the yield of TB case detection from such interventions. A significant portion of this figure, more than 40% (about 4.3 million), is not notified This pool of unidentified TB cases poses a risk for further transmission of TB. Contact investigation has been proposed as a worthwhile strategy to enhance early detection of TB cases and reduce transmission in high incidence localities [2, 3]. Given the paucity of data on the yield and contribution of TB case detection from contact investigation in these settings, the ability to assess the contribution of implementing this intervention in reducing transmission in these countries is limited [3]

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