Tuberculosis Contact Tracing Research Articles

Changes in TB contact tracing during the COVID-19 pandemic. An Irish single centre experience

Abstract Contact tracing following the diagnosis of tuberculosis (TB) is a crucial process in the identification and treatment of both secondary TB cases and also infected contacts who may require treatment for latent TB infection. During the COVID-19 pandemic, Public Health and Respiratory teams in the St Vincent’s University Hospital (SVUH) TB clinic in Dublin, Ireland, noted anecdotally that there appeared to be fewer contacts screened by public health services per index active TB case identified. To investigate this, we performed a retrospective review of the TB contact tracing service in SVUH, examining and comparing contact tracing of active TB cases in the 3 years prior to the pandemic (2017-2019) and four years thereafter (2020-2023). Results from 2017-2019 calendar years, prior to the COVID-19 pandemic noted an average of 4.77 contacts per index TB case (total 107 index cases and 510 contacts). In comparison, our data from 2020-2022 noted an average of 3.03 contacts per index TB case (total 59 index cases and 179 contacts). As pandemic restrictions were lifted again, we found our 2023 data to be more comparable to that of pre-pandemic times, noting 4.54 contacts per index case (total 22 index cases and 100 contacts). The reduction in TB contacts per index cases noted during the COVID-19 pandemic may reflect work and lifestyle changes over that time, particularly an increase in remote work but also social distancing. It is interesting that as the population emerged from the isolation measures of the pandemic, contact numbers returned quickly to pre-pandemic levels. In line with global concerns, our data highlights the ongoing workload of TB contact tracing locally and the importance of resource allocation for these services. Key messages • Our Irish centre experienced a notable but temporary reduction in contacts requiring screening by public health services, per index active TB case, during the COVID-19 pandemic. • In line with global concerns, our data highlights the ongoing workload of TB contact tracing locally and the importance of resource allocation for these services.

Implementation of Portable Digital Chest X-ray Machine for Tuberculosis Contact Tracing in Oyo and Osun States, Nigeria: A Formative Assessment

This paper presents a formative assessment for the implementation of mobile portable chest X-ray (PDX) machines for tuberculosis (TB) contact tracing in the Oyo and Osun states, Nigeria. This descriptive qualitative study was carried out in eight local government areas, and 24 focus group discussions and 30 key informant interviews were conducted using a four-stage sampling technique to select participants. Validated transcribed notes were entered and analyzed using Nvivo. The respondents’ ages ranged from 17 to 85 years, with a mean age of 42.08 ± 14.9 years, and 4.0% had a postgraduate degree. The majority of government officials stated that deploying the PDX machine for screening at the community level is the best means for implementation because it will offer a level of proximity convenience to the TB contacts and assuage concerns about the cost of transportation to the health facility. In addition, it was suggested that TB community screening should be carried out with screening for other health conditions such as high blood pressure and diabetes. This portable X-ray machine intervention, therefore, should be implemented at the community level for contact tracing to allow more TB contacts living with the index patient to be screened without proximity and transportation constraints.

Community tuberculosis screening, testing and care, Uganda.

To assess the effectiveness of a community-based tuberculosis and leprosy intervention in which village health teams and health workers conduct door-to-door tuberculosis screening, targeted screenings and contact tracing. We conducted a before-and-after implementation study in Uganda to assess the effectiveness of the community tuberculosis intervention by looking at reach, outputs, adoption and effectiveness of the intervention. Campaign 1 was conducted in March 2022 and campaign 2 in September 2022. We calculated percentages of targets achieved and compared case notification rates during the intervention with corresponding quarters in the previous year. We also assessed the leprosy screening. Over 5days, campaign 1 screened 1 289 213 people (2.9% of the general population), of whom 179 144 (13.9%) fulfilled the presumptive tuberculosis criteria, and 4043 (2.3%) were diagnosed with bacteriologically-confirmed tuberculosis; 3710 (91.8%) individuals were linked to care. In campaign 2, 5 134 056 people (11.6% of the general population) were screened, detecting 428 444 (8.3%) presumptive tuberculosis patients and 8121 (1.9%) bacteriologically-confirmed tuberculosis patients; 5942 individuals (87.1%) were linked to care. The case notification rate increased from 48.1 to 59.5 per 100 000 population in campaign 1, with a case notification rate ratio of 1.24 (95% confidence interval, CI: 1.22-1.26). In campaign 2, the case notification rate increased from 45.0 to 71.6 per 100 000 population, with a case notification rate ratio of 1.59 (95% CI: 1.56-1.62). Of the 176 patients identified with leprosy, 137 (77.8%) initiated treatment. This community tuberculosis screening initiative is effective. However, continuous monitoring and adaptations are needed to overcome context-specific implementation challenges.

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.

TB index case tracing in the Roma community in the Czech Republic.

Tuberculosis (TB) contact tracing and TB preventive treatment are key tools in preventing the transmission of TB with the aim of eliminating the disease. Our study seeks to demonstrate how the infection spread from an individual patient to the entire community and how proactive contact tracing facilitated prompt diagnosis and treatment. Our work was conducted as a retrospective analysis of the spread of TB infection within the Roma community in the Czech Republic, following the case of an index patient who succumbed to pulmonary TB. Several levels of care and preventive and treatment measures are outlined. Confirming the identity of the Mycobacterium tuberculosis strain was achieved using molecular methods. Among the 39 individuals examined, TB disease was detected in eight patients and TB infection was detected in six patients. The investigation of contacts within this group yielded positive results in 36% of cases, necessitating treatment. The study's findings provide evidence that actively tracing individuals at risk can lead to early detection of cases, prompt treatment, and prevention of further disease transmission. The study also indicates that the highest risk of infection occurs within the sick person's household and that young children under the age of 5 are most susceptible to falling ill.

Exploring Community Participation in Prevention and Care of Tuberculosis from Patients’, Healthcare Providers’ and Community Member’s Perspective, In Wolayta Zone, SNNPR, Ethiopia. A Qualitative Study

Background: In developing countries, tuberculosis (TB) continues to be the major cause of morbidity and mortality. To reduce the loss of lives and economical burden that TB poses up on citizens, early case detection and successful treatment of infected cases are very essential mainly with active community participation in prevention and care of TB. This study was aimed to explore community participation in prevention and care of TB in Wolayta Zone of SNNPR, Ethiopia. Method: Descriptive phenomenological research methodology was employed in the study. A total 24 participants were chosen using purposive sampling technique. Participants in the study were from various sections of society. Of these, 14 were TB patients on TB treatment and former TB patients who were recovered, 8 were health professionals and 2 were Key Informants which were selected from the community to provide key information. Data were gathered through focus groups and in-depth interviews. Using the Open Code and Colaizi 7 steps of descriptive phenomenological method data analysis was used. Interviews were audio recorded, verbatim transcribed, translated, and exhaustive description was written. Results: Community participation in prevention and care of TB in study area was high. Preventive participation and supportive participations were identified and these participations have their own goals in TB prevention and care. Preventive participation has focused on early case finding strategies like referring the suspect cases for TB diagnosis and contact tracing. Supportive participation has focused on treatment success such physical, economical, psychological and social supports which increase the patients adherence to treatment and as result increases treatment success rate. Conclusion. Our study revealed highto moderate community participation in tuberculosis prevention and care in the the study area. The finding is that the TB prevention and care strategy for eliminating TB will be operationally effective. In cumulative effect, the region might be able to meet the WHO's recommendations for the community TB prevention and care plan, which call for case notification of more than 70% and an 85% success rate for treatment and all seek to eliminating TB by 2030. Therefore, the study emphasizes the necessity for effective communication to be established between community and the health institutions. To further raise TB notification and treatment success rates, all feasible methods of utilizing community participation in TB care are advised.

Recommendations for contact tracing for tuberculosis - update 2023

The aim of contact tracing for tuberculosis is in addition to active case finding the detection of chains of infection and the prevention of the further spread of the disease. In this context, a careful selection of contact persons is necessary, depending on the type and duration of contact, to identify persons who are recently infected and therefore to increase the benefit of a preventive therapy and to avoid unnecessary testing of persons who are not at risk of infection. Since the last update of the recommendations on contact tracing, data on the use of interferon-y release assays (IGRAs) in children has been improved markedly. These are the preferred test in contact tracing of adults. For children, both IGRAs and the tuberculin skin test can be used equivalently. Rifampicin for 4 months, rifampicin and isoniazid for 3 months, or isoniazid for 9 months are recommended as preventive therapy in cases of confirmed infection.The implementation of the contact tracing in different age groups as well as legal framework conditions and socio-medical aspects and challenges are dealt with in detail. In addition, special cases, such as environmental screening in day-care centers, schools, or other community facilities, are discussed separately.

Comparing Additionality of Tuberculosis Cases Using GeneXpert or Smear-Based Active TB Case-Finding Strategies among Social Contacts of Index Cases in Nepal.

This study compares the yield and additionality of community-based active tuberculosis (TB) active case-finding strategies using either smear microscopy or GeneXpert as the TB diagnostic test. Active case-finding strategies screened social contacts of index cases and high-risk groups in four districts of Nepal in July 2017-2019. Two districts (Chitwan and Dhanusha) applied GeneXpert testing and two districts (Makwanpur and Mahotarri) used smear microscopy. Two control districts implemented standard national TB program activities. Districts implementing GeneXpert testing screened 23,657 people for TB, tested 17,114 and diagnosed 764 TB cases, producing a yield of 4.5%. Districts implementing smear microscopy screened 19,961 people for TB, tested 13,285 and diagnosed 437 cases, producing a yield of 3.3%. The screening numbers required were 31 for GeneXpert and 45.7 for smear districts. The test numbers required were 22.4 and 30.4 for GeneXpert and smear. Using the TB REACH additionality method, social contact tracing for TB through GeneXpert testing contributed to a 20% (3958/3322) increase in district-level TB notifications, smear microscopy 12.4% (3146/2798), and -0.5% (2553/2566) for control districts. Therefore, social contact tracing of TB index cases using GeneXpert testing should be implemented throughout Nepal within the TB FREE initiative to close the notification gap and accelerate progress toward END TB strategy targets.

Programmatic Cost-Effectiveness of a Second-Time Visit to Detect New Tuberculosis and Diabetes Mellitus in TB Contact Tracing in Myanmar.

Integration of diabetes mellitus screening in home visits for contact tracing for tuberculosis could identify hidden patients with either tuberculosis or diabetes mellitus. However, poor compliance to the first home screening has been reported. A second time visit not only increases screening compliance but also the cost. This study aimed to determine if an additional second time visit was cost effective based on the health system perspective of the tuberculosis contact tracing program in Myanmar. This cross-sectional study was based on usual contact tracing activity in the Yangon Region, Myanmar, from April to December 2018 with integration of diabetes mellitus screening and an additional home visit to take blood glucose tests along with repeated health education and counseling to stress the need for a chest X-ray. New tuberculosis and diabetes mellitus cases detected were the main outcome variables. Programmatic operational costs were calculated based on a standardized framework for cost evaluation on tuberculosis screening. The effectiveness of an additional home visit was estimated using disability-adjusted life years averted. The willingness to pay threshold was taken as 1250.00 US dollars gross domestic product per capita of the country. Single and additional home visits could lead to 42.5% and 65.0% full compliance and 27.2 and 9.3 additional years of disability-adjusted life years averted, respectively. The respective base costs and additional costs were 3280.95 US dollars and 1989.02 US dollars. The programmatic costs for an extra unit of disability-adjusted life years averted was 213.87 US dollars, which was lower than the willingness to pay threshold. From the programmatic perspective, conducting the second time visit for tuberculosis contact tracing integrated with diabetes mellitus screening was found to be cost effective.

Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi.

Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to improve uptake. Between May and December 2014, we randomised patient with TB who consented to participate in the trial to either standard of care (SOC) or intervention (PACTS) arms. Participants randomised to PACTS received one screening/triage tool (adapted from WHO integrated management of adolescent and adult illnesses [IMAI] guidelines) and sputum pots for each reported household contact. The tool guided participants through symptom screening; TPT (6-months of isoniazid) eligibility; and sputum collection for contacts. Patients randomised to SOC were managed in accordance with national guidelines, that is, they received verbal instruction on who to bring to clinics for investigation using national guidelines. The primary outcome was the proportion of adult contacts receiving treatment for TB within 3 months of randomisation. Secondary outcomes were the proportions of child contacts under age 5 years (U5Y) who were commenced on, and completed, TPT. Data were analyzed by logistic regression with random effects to adjust for household clustering. Two hundred and fourteen index TB participants were block-randomized from two sites (107 PACTS, reporting 418 contacts; and 107 SOC, reporting 420 contacts). Overall, 62.8% of index TB participants were HIV-positive and 52.1% were TB culture-positive. 250 otherwise eligible TB patients declined participation and 6 households (10 PACTS, 6 SOC) were lost to follow-up and were not included in the analysis. By three months, nine contacts (PACTS: 6, [1.4%]; SOC: 3, [0.7%]) had TB diagnosed, with no difference between groups (adjusted odds ratio [aOR]: 2.18, 95% CI: 0.60-7.95). Eligible PACTS contacts (37/96, 38.5%) were more likely to initiate TPT by 3-months compared to SOC contacts (27/101, 26.7%; aOR 2.27, 95% CI: 1.04-4.98). U5Y children in the PACTS arm (47/81 58.0%) were more likely to have initiated TPT before the 3-month visit compared to SOC children (36/89, 41.4%; aOR: 2.31, 95% CI: 1.05-5.06). A household-centred patient-delivered symptom screen and IPT eligibility assessment significantly increased timely TPT uptake among U5Y children, but did not significantly increase TB diagnosis. This model needs to be optimized for acceptability, given low participation, and investigated in other low resource settings. TRIAL REGISTRATION NUMBER: ISRCTN81659509 https://www.isrctn.com/ISRCTN81659509?q=&filters=conditionCategory:Respiratory,recruitmentCountry:Malawi,ageRange:Mixed&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search. 19 July 2012.

3 Outcomes of Tuberculosis contact tracing and predictors of success: a 10-year retrospective cohort analysis

3 Outcomes of Tuberculosis contact tracing and predictors of success: a 10-year retrospective cohort analysis

Linking nationwide health and social registry data to informthe policy for Tuberculosis contact tracing in Brazil.

ObjectivesMitigating the socioeconomic determinants of Tuberculosis (TB) and systematic screening of contacts and high-risk groups are targets of The World Health Organization (WHO) End TB Strategy by 2035. Our aim was to link socioeconomic information to TB datasets to inform policy makers in Brazil and contribute to addressing current challenges.
 ApproachFollowing a signed technical cooperation agreement with the Ministry of Health (MoH), we linked nationwide data on 1.405.682 registries of TB diagnosed between 2004 and 2019 in Brazil to 131.697.800 demographic and socioeconomic registries from the 100 Million Brazilian Cohort (2001-2018) previously linked to nationwide mortality data. We established close links with TB managers to understand the database, clean and deduplicate registries and to analyse the data. We took advantage of the data structure, to set up a cohort of household contacts of TB patients and produce estimates of TB incidence by subgroups of demographic and socioeconomic characteristics.
 ResultsThe interaction of the MoH was effective and facilitated by a robust TB Programme in the country. 567.999 (40,41%) TB cases were linked to the 100 Million Brazilian Cohort with high specificity (93.6%) and sensitivity (94.6%). Using family identifiers, we established the first TB case within a family unit (i.e., primary case) and followed their household contacts up to 15 years. We found the TB incidence among household contacts to be 427.8/100.000 person-years (95%CI 419.1-436.8). In the first year following the identification of the primary case, there was higher cumulative incidence among household contacts under 5 years of age, which was followed by a plateau of cases in this age group. Cummulative incidence in the other age groups presented a constant increase over time.
 ConclusionThe close collaboration with the MoH, the development of an effective linkage algorithm and the availability of large socioeconomic data allowed for a unique analysis of the high incidence of TB among household contacts. Findings reinforce need for constant dialogue among stakeholders to strengthen case detection by primary health care.

An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional study

BackgroundChildhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu.MethodsWe conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge.ResultsThe majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions.ConclusionThe childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

Tuberculosis contact tracing yield and associated factors in Uganda

BackgroundThe yield of tuberculosis (TB) contact tracing is historically low in Uganda. We determined factors associated with a positive contact tracing yield at an urban public TB clinic in Kampala, Uganda.MethodsWe reviewed contact tracing registers of index TB cases registered between 2015 and 2020 at Kitebi Health Center, a primary level facility. Contacts who had symptoms of TB were designated as having presumptive TB. A contact investigation that yielded a new TB case was designated as a positive yield. We used logistic regression to determine factors associated with a positive yield of contact tracing.ResultsOf 778 index TB cases, 455 (58.5%) had a contact investigation conducted. Index cases with a telephone contact in the unit TB register (adjusted odds ratio (aOR) 1.66, 95% CI 1.02–1.97, p = 0.036) were more likely to have a contact investigation conducted than those who did not. Of 1350 contacts, 105 (7.8%) had presumptive TB. Of these, 73 (69.5%) were further evaluated for active TB and 29 contacts had active TB. The contact tracing yield for active TB was therefore 2.1% (29/1,350). The odds of a positive yield increased tenfold with each additional presumptive contact evaluated for active TB (aOR 10.1, 95% CI 2.95–34.66, p < 0.001). Also, retreatment index TB cases were more likely to yield a positive contact (aOR 7.69 95% CI 2.08–25.00, p = 0.002) than to new cases.ConclusionTB contact tracing should aim to evaluate all contacts with presumptive TB and contacts of retreatment cases to maximise the yield of contact tracing.

The role of counselling in tuberculosis diagnostic evaluation and contact tracing: scoping review and stakeholder consultation of knowledge and research gaps

BackgroundTuberculosis (TB) care cascade analyses show large gaps at early stages, including care-seeking and diagnostic evaluation, where promising interventions to decrease attrition are urgently needed. Person-centered care is prioritized in the World Health Organization’s End TB strategy; yet little is known about how it is delivered and can be optimized. Recommendations for counselling, a core component of person-centered care, are largely limited to its role in improving TB treatment adherence. The role of counselling to close key diagnostic gaps in the care cascade is poorly understood.MethodsWe conducted a scoping review to identify evidence on the use of counselling at TB diagnosis, for both people with presumptive TB and index patients to promote patient retention and contact tracing. Using search terms for TB, diagnosis and counselling, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data and conducted a quality assessment. We used thematic analysis to identify key themes.ResultsAfter screening 1785 articles, we extracted data from 15 studies and determined that the major themes best corresponded to the following gaps in the TB care cascade: care-seeking, pre-diagnosis, and pre-treatment. Studies were conducted across varied settings including pharmacies, primary health centres, and clinics, primarily in high TB incidence countries. No study directly evaluated the impact of counselling on outcomes such as treatment initiation or retention in care. Included studies suggested counselling may play an important role in improving the uptake of diagnostic testing and contact tracing. Barriers to counselling included time and personnel requirements. Stakeholder consultation emphasized the importance of high-quality counselling as a core tenet of TB care.ConclusionData on the impact of counselling to improve TB case detection are absent from the literature. The shift towards person-centred care for TB presents an opportunity to incorporate counselling during earlier stages of the TB care cascade; however, evidence-based approaches are needed. Implementation research is needed to operationalize and evaluate counselling to strengthen high-quality TB care delivery.

Household Contact Tracing With Intensified Tuberculosis and Human Immunodeficiency Virus Screening in South Africa: A Cluster-Randomized Trial.

BackgroundHousehold contact tracing for tuberculosis (TB) may facilitate diagnosis and access to TB preventive treatment (TPT). We investigated whether household contact tracing and intensive TB/human immunodeficiency virus (HIV) screening would improve TB-free survival.MethodsHousehold contacts of index TB patients in 2 South African provinces were randomized to home tracing and intensive HIV/TB screening or standard of care (SOC; clinic referral letters). The primary outcome was incident TB or death at 15 months. Secondary outcomes included tuberculin skin test (TST) positivity in children ≤14 years and undiagnosed HIV.ResultsFrom December 2016 through March 2019, 1032 index patients (4459 contacts) and 1030 (4129 contacts) were randomized to the intervention and SOC arms. Of intervention arm contacts, 3.2% (69 of 2166) had prevalent microbiologically confirmed TB. At 15 months, the cumulative incidence of TB or death did not differ between the intensive screening (93 of 3230, 2.9%) and SOC (80 of 2600, 3.1%) arms (hazard ratio, 0.90; 95% confidence interval [CI], .66–1.24). TST positivity was higher in the intensive screening arm (38 of 845, 4.5%) compared with the SOC arm (15 of 800, 1.9%; odds ratio, 2.25; 95% CI, 1.07–4.72). Undiagnosed HIV was similar between arms (41 of 3185, 1.3% vs 32 of 2543, 1.3%; odds ratio, 1.02; 95% CI, .64–1.64).ConclusionsHousehold contact tracing with intensive screening and referral did not reduce incident TB or death. Providing referral letters to household contacts of index patients is an alternative strategy to home visits.Clinical Trials RegistrationISRCTN16006202.

Integrating partner notification and contact tracing services across Europe: findings from the Integrate project

BackgroundPartner notification/contact tracing (PN/CT) is a process whereby people diagnosed with an infectious disease notify their sexual and needle-sharing partners/close contacts and invite them for testing and treatment due to exposure to the disease. PN is a necessary testing and prevention tool supported by the European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO). Traditionally, PN efforts have been siloed within disease areas, with separate pathways and systems responsible for specific diseases. The INTEGRATE project sought to improve PN/CT outcomes by sharing knowledge across diseases and countries.MethodsINTEGRATE used two mapping exercises to assess the PN landscape in Europe and identify areas for integration and cross-learnings for Sexually Transmitted Infections (STIs) and Tuberculosis. Mapping exercises were surveys to 29 consortium partners and in-depth qualitative interviews at four selected pilot sites: Ireland, Greece, Romania and Italy.ResultsAreas for the improvement of PN/CT emerged: lack of resources and insufficient staff training, different modes of disease transmission, country-specific laws and regulations, the advent of General Data Protection Regulation (GDPR), differences in healthcare system pathways, historical concerns, and cultural differences. Activities highlighted key areas PN/CT outcomes could be improved, including PN/CT specific trainings for staff, improving knowledge on laws, regulations, guidelines and pathways and creating a country/region specific Standard Operating Procedures (SOPs) for PN/CT, incorporating information on all four disease areas. Findings were analyzed and three key areas were identified and implemented for knowledge transfer namely the creation of an online repository of European country guidelines, the transfer of SOPs and PN training in pilot sites.ConclusionA major finding of the project was challenges associated with incorporating Tuberculosis (TB) contact tracing alongside other infectious diseases. Professionals in the field, emphasized that integrating TB contact tracing with the other disease areas would be challenging and arguably unjustified, due to the different ways of transmission of TB and because well-established historical pathways for TB in public health systems already exist. However, the success of TB services presents an ideal model to draw from when strengthening PN systems for other infectious diseases.

Contact tracing is associated with treatment success of index tuberculosis cases in Uganda

OBJECTIVE:To determine the effect of contact tracing on the treatment outcomes of index tuberculosis (TB) cases in Uganda.METHODS:We evaluated TB cases registered at an urban public health facility in Uganda in 2015–2020. We extracted data from the unit’s TB and contact tracing registers. Treatment outcomes were classified as cure, loss to follow-up, death and treatment failure. Treatment success was the sum of cure and treatment completion.RESULTS:Among 778 TB cases, contact tracing was conducted for 455 (58.5%). Compared with cases without contract tracing (n=323), cases with contract tracing (n=455) had higher treatment success (92.5% vs 79.3%) and cure rates (57.1% vs 39.9%) and lower loss to follow-up (3.5% vs 9.3%), treatment failure (0.4% vs 1.6%) and death (3.5% vs 9.9%) (P<0.001). Contact tracing was associated with higher odds of treatment success (adjusted odds ratio (aOR) 3.00, 95% CI 1.92–4.70, P<0.001) and cure (aOR 3.11, 95% CI 1.97–4.90, P<0.001), and lower odds of loss to follow-up (aOR 0.33, (0.13–0.83), P=0.018) and death (aOR 0.38, (0.20–0.72), P=0.003).CONCLUSION:TB contact tracing should be conducted consistently not only for the benefit of identifying new TB cases but also to promote treatment success of index cases.

Tuberculosis contact investigation results among paediatric contacts in low-incidence settings in Finland

Tuberculosis (TB) risk is highest immediately after primary infection, and young children are vulnerable to rapid and severe TB disease. Contact tracing should identify infected children rapidly and simultaneously target resources effectively. We conducted a retrospective review of the paediatric TB contact tracing results in the Hospital District of Helsinki and Uusimaa from 2012 to 2016 and identified risk factors for TB disease or infection. Altogether, 121 index cases had 526 paediatric contacts of whom 34 were diagnosed with TB disease or infection. The maximum delay until first contact investigation visit among the household contacts under 5 years of age with either TB disease or infection was 7 days. The yield for TB disease or infection was 4.6% and 12.8% for household contacts, 0.5% and 0% for contacts exposed in a congregate setting and 1.4% and 5.0% for other contacts, respectively. Contacts born in a TB endemic country (aOR 3.07, 95% CI 1.10–8.57), with household exposure (aOR 2.96, 95% CI 1.33–6.58) or a sputum smear positive index case (aOR 3.96, 95% CI 1.20–13.03) were more likely to have TB disease or infection.Conclusions: Prompt TB investigations and early diagnosis can be achieved with a well-organised contact tracing structure. The risk for TB infection or disease was higher among contacts with household exposure, a sputum smear positive index case or born in a TB endemic country. Large-scale investigations among children exposed in congregate settings can result in a very low yield and should be cautiously targeted.What is Known:• Vulnerable young children are a high priority in contact tracing and should be evaluated as soon as possible after TB exposureWhat is New:• Prompt investigations for paediatric TB contacts and early diagnosis of infected children can be achieved with a well-organised contact tracing structure• Large-scale investigations among children exposed in congregate settings can result in a very low yield and should be cautiously targeted

Protective impacts of household-based tuberculosis contact tracing are robust across endemic incidence levels and community contact patterns.

There is an emerging consensus that achieving global tuberculosis control targets will require more proactive case finding approaches than are currently used in high-incidence settings. Household contact tracing (HHCT), for which households of newly diagnosed cases are actively screened for additional infected individuals is a potentially efficient approach to finding new cases of tuberculosis, however randomized trials assessing the population-level effects of such interventions in settings with sustained community transmission have shown mixed results. One potential explanation for this is that household transmission is responsible for a variable proportion of population-level tuberculosis burden between settings. For example, transmission is more likely to occur in households in settings with a lower tuberculosis burden and where individuals mix preferentially in local areas, compared with settings with higher disease burden and more dispersed mixing. To better understand the relationship between endemic incidence levels, social mixing, and the impact of HHCT, we developed a spatially explicit model of coupled household and community transmission. We found that the impact of HHCT was robust across settings of varied incidence and community contact patterns. In contrast, we found that the effects of community contact tracing interventions were sensitive to community contact patterns. Our results suggest that the protective benefits of HHCT are robust and the benefits of this intervention are likely to be maintained across epidemiological settings.