Effective Contact Tracing Research Articles

Data protection during the coronavirus crisis.

Smartphone apps to track SARS-CoV 2 infections need to fulfill certain minimal requirements to guarantee privacy and justify their use under data protection laws.

Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: a modelling study

BackgroundAs lockdown measures to slow the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection begin to ease in the UK, it is important to assess the impact of any changes in policy, including school reopening and broader relaxation of physical distancing measures. We aimed to use an individual-based model to predict the impact of two possible strategies for reopening schools to all students in the UK from September, 2020, in combination with different assumptions about relaxation of physical distancing measures and the scale-up of testing.MethodsIn this modelling study, we used Covasim, a stochastic individual-based model for transmission of SARS-CoV-2, calibrated to the UK epidemic. The model describes individuals' contact networks stratified into household, school, workplace, and community layers, and uses demographic and epidemiological data from the UK. We simulated six different scenarios, representing the combination of two school reopening strategies (full time and a part-time rota system with 50% of students attending school on alternate weeks) and three testing scenarios (68% contact tracing with no scale-up in testing, 68% contact tracing with sufficient testing to avoid a second COVID-19 wave, and 40% contact tracing with sufficient testing to avoid a second COVID-19 wave). We estimated the number of new infections, cases, and deaths, as well as the effective reproduction number (R) under different strategies. In a sensitivity analysis to account for uncertainties within the stochastic simulation, we also simulated infectiousness of children and young adults aged younger than 20 years at 50% relative to older ages (20 years and older).FindingsWith increased levels of testing (between 59% and 87% of symptomatic people tested at some point during an active SARS-CoV-2 infection, depending on the scenario), and effective contact tracing and isolation, an epidemic rebound might be prevented. Assuming 68% of contacts could be traced, we estimate that 75% of individuals with symptomatic infection would need to be tested and positive cases isolated if schools return full-time in September, or 65% if a part-time rota system were used. If only 40% of contacts could be traced, these figures would increase to 87% and 75%, respectively. However, without these levels of testing and contact tracing, reopening of schools together with gradual relaxing of the lockdown measures are likely to induce a second wave that would peak in December, 2020, if schools open full-time in September, and in February, 2021, if a part-time rota system were adopted. In either case, the second wave would result in R rising above 1 and a resulting second wave of infections 2·0–2·3 times the size of the original COVID-19 wave. When infectiousness of children and young adults was varied from 100% to 50% of that of older ages, we still found that a comprehensive and effective test–trace–isolate strategy would be required to avoid a second COVID-19 wave.InterpretationTo prevent a second COVID-19 wave, relaxation of physical distancing, including reopening of schools, in the UK must be accompanied by large-scale, population-wide testing of symptomatic individuals and effective tracing of their contacts, followed by isolation of diagnosed individuals.FundingNone.

ACSM Call to Action Statement: COVID-19 Considerations for Sports and Physical Activity.

ACSM Call to Action Statement: COVID-19 Considerations for Sports and Physical Activity.

Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19)

ObjectiveContact tracing is a central public health response to infectious disease outbreaks, especially in the early stages of an outbreak when specific treatments are limited. Importation of novel coronavirus (COVID-19)...

Test, Trace, and Isolate: COVID-19 and the Canadian Constitution

Executive Summary Contact tracing is essential to controlling the spread of infectious disease and plays a central role in plans to safely loosen COVID-19 physical distancing measures and begin to reopen the economy. Contact tracing apps, used in conjunction with established human contact tracing methods, could serve as part of Canada’s “test, trace, and isolate” strategy. In this brief, we consider the potential benefits of using contract tracing apps to identify people who have been exposed to COVID-19, as well as the limitations of using this technology. We also consider the privacy implications of different app design choices. Finally, we consider how the privacy impacts of contact tracing apps could be evaluated under the Canadian Charter of Rights and Freedoms, which provides a framework for balancing competing rights and interests. We argue that so long as apps are carefully constructed and the information they reveal is appropriately safeguarded, tracing apps may have a role to play in the response of a free and democratic society to the Covid 19 pandemic. 1. Improving the Efficiency of Human Contact Tracing: The public health goal of a contact tracing app should be to integrate with human contact tracing and make it more efficient rather than replace it. We need to keep humans in the loop to ensure accuracy and to maintain the important social functions of contact tracing, which includes educating people about risks and helping them access social supports. 2. Privacy Choices: Currently, the most privacy-protective design for contact tracing apps makes use of proximity data (via Bluetooth) through a decentralized design. This method is receiving significant technical support from Apple and Google. However, this method fails to integrate with the human contact tracing system. Other options, such as the use of location logs or a centralized registration system, are more aligned with the public health goal of integration with human contact tracing but raise additional privacy questions. In addition to the constitutional questions raised by these privacy choices, there are two important considerations. First, social trust is important. If individuals do not feel comfortable with using a particular contact tracing app there will not be the large-scale uptake needed to make these an effective addition to human contact tracing. Second, due to various technical challenges, it is difficult to make effective contact tracing apps utilizing proximity data unless one uses the method supported by Apple and Google. However, Google and Apple prohibit app developers both from utilizing centralized methods and from utilizing location data. 3. Constitutional Balancing: Our privacy commissioners have discussed the need to assess these privacy choices according to the principles of necessity and proportionality. The Canadian Charter provides an important framework for thinking about these principles as it provides us with a framework for how to balance rights and interests in a free and democratic society. The Charter requires that we choose the most privacy-protective app design that meets the public health goal, so long as the benefits of meeting this goal outweigh its deleterious effects on privacy. This requires a reasonable belief in the efficacy of such an app. It also requires an assessment of the nature of the benefits, which are not just the economic benefits of reopening the economy. The currently prevailing restrictions on movement and work are themselves limitations of basic rights and liberties. Individuals who self-isolate in situations of poverty, precarious housing, mental health challenges, abusive relationships, or other vulnerabilities face challenges that affect their security of the person. There are also broader effects on equality and human flourishing. If contact tracing, enhanced by an app, reduces the need for restrictions in the form of self-isolation, it promotes other Charter rights and values (e.g., security of the person) which must be balanced against the potential infringement of privacy rights.

Policy capacity and Singapore’s response to the COVID-19 pandemic

ABSTRACT Despite its excellent public healthcare system and efficient public administration, Singapore has been severely affected by the COVID-19 pandemic. While fatalities in the city-state remain low and contact tracing efforts have been largely successful, it has nonetheless experienced high rates of infection and the emergence of large infection clusters in its foreign worker dormitories. This paper analyses this dual-track policy outcome – low fatalities but high infection rates – from a policy capacity perspective. Specifically, the policy capacities that had contributed to Singapore’s low fatality rates and effective contact tracing are identified while the capacity deficiencies that may have caused its high rates of infection are discussed. In doing so, I argue that the presence of fiscal, operational and political capacities that were built up after the SARS crisis had contributed to Singapore’s low fatality rate and contact tracing capabilities while deficiencies in analytical capacities may explain its high infection rate.

Application of Mobile Technology in Community Transmission Surveillance for 2020 Corona Virus Disease

The corona virus disease (COVID-19) outbreak reached community transmission scenario in Nigeria less than 2 months from its first case on 27thFebruary 2020; a scenario which requires aggressive and effective contact tracing, identification, monitoring and reporting of disease trend. Surveillance is one of the working strategies in responding to community spread. Currently the COVID-19 community spread response mechanism relies on contact tracing and community testing, requiring a huge testing capacity, and its coverage is bound to be undermined by the lack of accessibility to the typical rural Nigerians. Massive testing is currently threatened by the short supply of test kits reported globally, inadequate trained manpower and limited molecular laboratories and testing centers, which cause delay in sample certification. This paints a picture of a massive unreached population in our communities and a predictable escalation of community transmission due to non- or untimely identification, isolation and management of cases. These gaps could be closed by the application of an appropriate tool that engages remote and real-time functions into the process. This article documents the feasibility of employing the mobile telephone opportunities for community transmission monitoring and case reporting of 2020 COVID-19 pandemic, with crowdsourcing and whistle-blowing effects; as an effective alternative to indefinite single case recording and unidirectional contact tracing.

Use of a Real-Time Locating System for Contact Tracing of Health Care Workers During the COVID-19 Pandemic at an Infectious Disease Center in Singapore: Validation Study.

BackgroundIn early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting.ObjectiveThis study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore.MethodsOver a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers.ResultsOf 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%).ConclusionsRTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary.

A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement-Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak.

A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement-Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak.

Leveraging Africa's preparedness towards the next phase of the COVID-19 pandemic

Leveraging Africa's preparedness towards the next phase of the COVID-19 pandemic

Two Months of COVID-19 Pandemic in Nigeria: Distribution and responses of the Nigerian Media

This study reviewed the distribution of and Nigerian Media responses to the COVID-19 pandemic within the first two months (February 27 to April 30 2020) of its outbreak in Nigeria. Using data collected from the websites of the Nigeria Centre for Disease Control, NCDC and Worldometer, and analysed in simple percentages and presented in tables and charts, the study showed that by April 30, 2020, the total confirmed, active, recovered and death cases stood at 1932, 1555, 319 and 58 respectively; an indication of an alarming spread. The distribution of the disease saw Lagos (epicentre of the disease), Kano and FCT collectively accounting for 71.07% of confirmed cases, 71.45% of active, 73.67% of death, and 46.55% of recovered cases. The initial mode of spread was through contact; however, as of April 30, 2020, 79% of new cases were through contact and incomplete epidemiological link; an indication of possible community transmission. The Nigerian media responded adequately and aggressively to the outbreak by setting the agenda and providing regular updates of government, private and individual efforts in containing the spread of the disease. By the conclusion of this study, over 40 healthcare workers had tested positive to SARS-CoV-2; thus, challenging the government to intensify efforts in curbing community transmission by ensuring effective contact tracing, testing, isolation and treatment. How to cite this article:Izah SC, Iniamagha I, Sylva L. Two Months of COVID-19 Pandemic in Nigeria: Distribution and responses of the Nigerian Media. Epidem Int 2020; 5(1): 32-44. DOI: https://doi.org/10.24321/2455.7048.202015

Peer-to-Peer Contact Tracing: Development of a Privacy-Preserving Smartphone App.

BackgroundThe novel coronavirus disease 2019 (COVID-19) pandemic is an urgent public health crisis, with epidemiologic models predicting severe consequences, including high death rates, if the virus is permitted to run its course without any intervention or response. Contact tracing using smartphone technology is a powerful tool that may be employed to limit disease transmission during an epidemic or pandemic; yet, contact tracing apps present significant privacy concerns regarding the collection of personal data such as location.ObjectiveThe aim of this study is to develop an effective contact tracing smartphone app that respects user privacy by not collecting location information or other personal data.MethodsWe propose the use of an anonymized graph of interpersonal interactions to conduct a novel form of contact tracing and have developed a proof-of-concept smartphone app that implements this approach. Additionally, we developed a computer simulation model that demonstrates the impact of our proposal on epidemic or pandemic outbreak trajectories across multiple rates of adoption.ResultsOur proof-of-concept smartphone app allows users to create “checkpoints” for contact tracing, check their risk level based on their past interactions, and anonymously self-report a positive status to their peer network. Our simulation results suggest that higher adoption rates of such an app may result in a better controlled epidemic or pandemic outbreak.ConclusionsOur proposed smartphone-based contact tracing method presents a novel solution that preserves privacy while demonstrating the potential to suppress an epidemic or pandemic outbreak. This app could potentially be applied to the current COVID-19 pandemic as well as other epidemics or pandemics in the future to achieve a middle ground between drastic isolation measures and unmitigated disease spread.

Deciphering the power of isolation in controlling COVID-19 outbreaks

Deciphering the power of isolation in controlling COVID-19 outbreaks

Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts

BackgroundIsolation of cases and contact tracing is used to control outbreaks of infectious diseases, and has been used for coronavirus disease 2019 (COVID-19). Whether this strategy will achieve control depends on characteristics of both the pathogen and the response. Here we use a mathematical model to assess if isolation and contact tracing are able to control onwards transmission from imported cases of COVID-19.MethodsWe developed a stochastic transmission model, parameterised to the COVID-19 outbreak. We used the model to quantify the potential effectiveness of contact tracing and isolation of cases at controlling a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-like pathogen. We considered scenarios that varied in the number of initial cases, the basic reproduction number (R0), the delay from symptom onset to isolation, the probability that contacts were traced, the proportion of transmission that occurred before symptom onset, and the proportion of subclinical infections. We assumed isolation prevented all further transmission in the model. Outbreaks were deemed controlled if transmission ended within 12 weeks or before 5000 cases in total. We measured the success of controlling outbreaks using isolation and contact tracing, and quantified the weekly maximum number of cases traced to measure feasibility of public health effort.FindingsSimulated outbreaks starting with five initial cases, an R0 of 1·5, and 0% transmission before symptom onset could be controlled even with low contact tracing probability; however, the probability of controlling an outbreak decreased with the number of initial cases, when R0 was 2·5 or 3·5 and with more transmission before symptom onset. Across different initial numbers of cases, the majority of scenarios with an R0 of 1·5 were controllable with less than 50% of contacts successfully traced. To control the majority of outbreaks, for R0 of 2·5 more than 70% of contacts had to be traced, and for an R0 of 3·5 more than 90% of contacts had to be traced. The delay between symptom onset and isolation had the largest role in determining whether an outbreak was controllable when R0 was 1·5. For R0 values of 2·5 or 3·5, if there were 40 initial cases, contact tracing and isolation were only potentially feasible when less than 1% of transmission occurred before symptom onset.InterpretationIn most scenarios, highly effective contact tracing and case isolation is enough to control a new outbreak of COVID-19 within 3 months. The probability of control decreases with long delays from symptom onset to isolation, fewer cases ascertained by contact tracing, and increasing transmission before symptoms. This model can be modified to reflect updated transmission characteristics and more specific definitions of outbreak control to assess the potential success of local response efforts.FundingWellcome Trust, Global Challenges Research Fund, and Health Data Research UK.

The fourth national anti-tuberculosis drug resistance survey in Peru.

BACKGROUND: Peru has one of the highest burdens of multidrug-resistant tuberculosis (MDR-TB), but universal drug susceptibility testing (DST) has not yet been achieved.OBJECTIVE: To estimate the proportion of drug resistance among smear-positive TB patients in Peru.DESIGN: From September 2014 to March 2015, we performed a national drug resistance survey of patients aged ≥15 years; TB was diagnosed based on sputum smear positivity. We performed DST at the National Reference Laboratory of the Peruvian National Institute of Health, Lima, Peru, using the proportion method in Middlebrook 7H10 agar for four first-line drugs and six second-line drugs, and the Wayne method for pyrazinamide.RESULTS: Of the 1908 new and 272 previously treated patients included in the analysis, 638 (29.3%) patients had resistance to at least one first-line drug. MDR-TB was diagnosed in 7.3% of new and 16.2% of previously treated patients (P < 0.001). There were five (0.2%) patients with extensively drug-resistant TB.CONCLUSION: MDR-TB has increased to 7.3% in new patients from 5.3% in the previous survey, indicating that resistance to anti-tuberculosis drugs is increasing in Peru. Ongoing community transmission of resistant strains highlights an urgent need for early diagnosis, optimised treatment and effective contact tracing of MDR-TB patients.

A Strategy for Effective Tuberculosis Contact Tracing in Botswana

Botswana has witnessed the highest TB rates in the southern African countries, ranking the fourth after South Africa, Swaziland, and Zimbabwe. In 2012, the TB rate was, on average, 531/100 000 population. About 2 380 contacts out of a possible 8 110 (amounting to 29.30%) were traced nationally (Botswana 2011:8), indicating a potential gap of 5 730, which was yet to be traced in 2011. The TBCT strategies might be inadequate leading to absence of screening and treating TB contacts and reducing PTB related deaths. The purpose of this study was to describe utilisation of current TBCT and develop a strategy for a more effective TBCT in Botswana. Data were collected through a quantitative cross-sectional research design. The study further described the association between TBCT strategies and practices and determined the gaps, challenges, and needs in the TBCT. Results revealed under-tracing of contacts in the number of registered and enumerated TB contacts. The results further established the risk of mixing TB contacts and general patients. The differences in the perceptions and knowledge of the cause of TB, as well as poor utilisation of the current programmes by the PTB patients, denotes the need for aggressive awareness-raising and health promotion strategies. The results were used to develop an alternative plan, the IC-TBCT, which has the potential to trace all TB contacts. The approach encourages participation, active accountability and involvement of the beneficiaries in all efforts aiming at early contact identification and reducing the incidence of PTB.

The Effectiveness of Public Health Interventions Against COVID-19: Lessons from the Singapore Experience

Background: This study conducts a counterfactual analysis, using the case of Singapore, a country fairly successful in suppressing community spread of COVID-19, to explore what the trajectory of COVID-19 infection might have been in Singapore had the government intervention not focused on containment, but rather on mitigation or uninhibited spread. Methods: We developed an SEIR model to estimate the number of COVID-19 infection cases in Singapore and deaths, under different public health intervention compared to the containment interventions implemented in Singapore. Finding: Under the Singapore containment interventions, we would expect a peak in infected cases to occur 3 months from January 23, 2020 [100% confidence range (CR), 2·2 to 4]. The infected cases of COVID-19 over 8·6 months is projected to be 2,488 [1,814 to 4,510]; representing 0·044% of the total population [0·032 to 0·081]. Deaths is estimated to be 25 [9 to 57]. In comparison, a mitigation intervention with 20% quarantine rate, would delay the time to peak infection by an estimated 5·2 months, prolong duration of the infection by 12·4 months, cumulative infected cases 1,388-fold, and deaths 1,371-fold. Likewise, a mitigation intervention with 40% quarantine rate, compared to the Singapore containment intervention could delay the time to peak infection by 7 months, extend the infection surge by 21 months, and increase cumulative infected cases and deaths 727-fold. Finally, a strategy of uninhibited spread would increase the time to peak infection by 2·9 months, duration of infection by 8 months, increase cumulative infected cases 1,863-fold and deaths 1,840-fold. Interpretation: Early public health measures in the context of targeted, aggressive containment — such as swift and effective contact tracing and quarantine – was likely responsible for suppressing the number of COVID-19 infections in Singapore. Funding Statement: The project was funded by the Singapore Ministry of Health’s National Medical Research Council. Declaration of Interests: There is no conflict of interests.

A Review Of Quarantine Period In Relation To Incubation Period Of SARS-CoV-2

Introduction: The period from exposure to a potential pathogen to the manifestation of symptoms, i.e. the incubation period, is time the virus spends replicating in the host. An estimation of this period and subsequent quarantine of the host can limit potential spread, particularly in asymptomatic carriers. Effective contact tracing, length of self-quarantine, repeat testing, and understanding of disease transmission are all contingent on a true estimation of this incubation period.

Epidemiologic Response to the First Case of COVID-19 in Nigeria

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in an unprecedented global health security challenge, economic downturns and psychosocial disruptions. First reported in Wuhan, China, the epidemic swiftly spread to over 200 countries and territories. In Nigeria, the first confirmed COVID-19 case was imported via air travel on 24^th of February 2020 and Confirmed on 27^th of February 2020. Minimal public health surveillance activities were initiated before then. In response to the confirmation of COVID-19, incident management activities, epidemiologic surveillance, contact tracing, infection, prevention and control trainings, COVID-19 testing and activation of isolation and treatment centers were immediately implemented in Ogun State. The objective of the outbreak investigation in Ogun State was to determine the magnitude of the outbreak, characterize the outbreak, and implement disease detection and response activities. This report documents and reflects on the steps taken to mitigate the initial spread of COVID-19 and the outbreak response activities in Ogun State, Nigeria. Adequate risk communication, robust surveillance, effective contact tracing and isolation of primary contacts of the first confirmed case in Nigeria as well as implementation of infection, prevention and control measures were pivotal tools that helped to curtail the initial spread of the infection. Operative collaboration between all stakeholders involved in response and surveillance to emerging dangers is necessary to detect cases early and to implement adequate preventive and control measures.

A review of management of latent tuberculosis infection (LTBI) in a TB contact tracing service in Cork, Ireland

Introduction Latent Tuberculosis Infection (LTBI) is defined as a persistent immune response to previously acquired Mycobacterium Tuberculosis without evidence of active TB. LTBI, whilst being non-contagious, may become active in 10% of those who acquire it over the remainder of their life. Contact tracing amongst those exposed to a person with active TB is a core public health function to identify people with LTBI. Ideally, all patients identified with LTBI should be offered chemoprophylaxis to prevent disease progression. Monitoring of those taking chemoprophylaxis is important to monitor compliance, treatment completion rates and to observe for adverse events. Good communication between primary care and public health services is vital to achieve optimal contact tracing processes and subsequent management of patients identified with LTBI. The aims of this study were: – to determine the rate of detection of LTBI in contact screening in the Cork region during 2014 and 2015; – to assess initiation and completion rates of chemoprophylaxis. Methods This study was a retrospective study conducted in the Department of Public Health, HSE-South, Cork, Ireland. Data was collected from a prospectively managed departmental contact tracing database which was initiated in 2013. Results There were 52 and 66 cases of TB notified in Cork in 2014 and 2015 respectively. 793 contacts were screened in 2015 compared to 289 in 2014, however the percentage of those diagnosed with latent TB remained unchanged (21%). 111 of 166 patients were commenced on chemoprophylaxis in 2015 and 39 of 57 patients in 2014. Thirty-two and 84 patients completed chemoprophylaxis in 2014 and 2015 respectively. The most common reason for non-completion of chemoprophylaxis was side effects from the medication itself. Discussion The number of patients initiating and completing chemoprophylaxis varied over the two-year period. Trends should be further monitored. A national information system on contact tracing and management of LTBI outcomes does not exist in Ireland at present. Access to a robust reporting system would assist with the delivery of effective contact tracing in relation to TB. An electronic health record accessible to all caregivers in primary and secondary care would also be beneficial. Close contact with primary care i.e. GP is important to ensure that everyone is aware of the treatment plan and any ongoing issues that may arise e.g. reaction to medications. Conclusions The high non-completion rate in 2015 probably reflects factors particular to a cohort within this group (young, socialising, domino effect of one discontinuing medication). Access to a robust reporting system is essential to the delivery of effective contact tracing in relation to TB. Limitations This study only includes one area of Ireland. LTBI detection rates identified by contact tracing and outcomes of LTBI management should be estimated nationally and in other HSE areas to compare practices and outcomes with other countries and across different HSE areas. Suggestions for future research A future challenge for public health is how to further convince patients of the benefits of LTBI treatment. Future research should focus on how to provide an integrated health service to maximize uptake and completion of chemoprophylaxis for maximum societal benefit.