Extending ‘Contact Tracing’ into the Community within a 50-Metre Radius of an Index Tuberculosis Patient Using Xpert MTB/RIF in Urban, Pakistan: Did It Increase Case Detection?

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Currently, only 62% of incident tuberculosis (TB) cases are reported to the national programme in Pakistan. Several innovative interventions are being recommended to detect the remaining ‘missed’ TB cases. One such intervention involved expanding contact investigation to the community using the Xpert MTB/RIF test.

Methods

This was a before and after intervention study involving retrospective record review. Passive case finding and household contact investigation was routinely done in the pre-intervention period July 2011-June 2013. Four districts with a high concentration of slums were selected as intervention areas; Lahore, Rawalpindi, Faisalabad and Islamabad. Here, in the intervention period, July 2013-June 2015, contact investigation beyond household was conducted: all people staying within a radius of 50 metres (using Geographical Information System) from the household of smear positive TB patients were screened for tuberculosis. Those with presumptive TB were investigated using smear microscopy and the Xpert MTB/RIF test was performed on smear negative patients. All the diagnosed TB patients were linked to TB treatment and care.

Results

A total of 783043 contacts were screened for tuberculosis: 23741(3.0%) presumptive TB patients were identified of whom, 4710 (19.8%) all forms and 4084(17.2%) bacteriologically confirmed TB patients were detected. The contribution of Xpert MTB/RIF to bacteriologically confirmed TB patients was 7.6%. The yield among investigated presumptive child TB patients was 5.1%. The overall yield of all forms TB patients among investigated was 22.3% among household and 19.1% in close community. The intervention contributed an increase of case detection of bacteriologically confirmed tuberculosis by 6.8% and all forms TB patients by 7.9%.

Conclusion

Community contact investigation beyond household not only detected additional TB patients but also increased TB case detection. However, further long term assessments and cost-effectiveness studies are required before national scale-up.

Related collections

Most cited references 12

Record: found
Abstract: found
Article: not found

Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial

Elizabeth L. Corbett, Tsitsi Bandason, Trinh Duong … (2010)

Summary Background Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmission. Methods Clusters of neighbourhoods in the high-density residential suburbs of Harare, Zimbabwe, were randomised to receive six rounds of active case finding at 6-monthly intervals by either mobile van or door-to-door visits. Randomisation was done by selection of discs of two colours from an opaque bag, with one disc to represent every cluster, and one colour allocated to each intervention group before selection began. In both groups, adult (≥16 years) residents volunteering chronic cough (≥2 weeks) had two sputum specimens collected for fluorescence microscopy. Community health workers and cluster residents were not masked to intervention allocation, but investigators and laboratory staff were masked to allocation until final analysis. The primary outcome was the cumulative yield of smear-positive tuberculosis per 1000 adult residents, compared between intervention groups; analysis was by intention to treat. The secondary outcome was change in prevalence of culture-positive tuberculosis from before intervention to before round six of intervention in 12% of randomly selected households from the two intervention groups combined; analysis was based on participants who provided sputum in the two prevalence surveys. This trial is registered, number ISRCTN84352452. Findings 46 study clusters were identified and randomly allocated equally between intervention groups, with 55 741 adults in the mobile van group and 54 691 in the door-to-door group at baseline. HIV prevalence was 21% (1916/9060) and in the 6 months before intervention the smear-positive case notification rate was 2·8 per 1000 adults per year. The trial was completed as planned with no adverse events. The mobile van detected 255 smear-positive patients from 5466 participants submitting sputum compared with 137 of 4711 participants identified through door-to-door visits (adjusted risk ratio 1·48, 95% CI 1·11–1·96, p=0·0087). The overall prevalence of culture-positive tuberculosis declined from 6·5 per 1000 adults (95% CI 5·1–8·3) to 3·7 per 1000 adults (2·6–5·0; adjusted risk ratio 0·59, 95% CI 0·40–0·89, p=0·0112). Interpretation Wide implementation of active case finding, particularly with a mobile van approach, could have rapid effects on tuberculosis transmission and disease. Funding Wellcome Trust.

0 comments Cited 131 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Active case finding of tuberculosis: historical perspective and future prospects.

T C Mohan, J Golub, R Chaisson … (2005)

Despite a history of remarkable scientific achievements in microbiology and therapeutics, tuberculosis (TB) continues to pose an extraordinary threat to human health. Case finding and treatment of TB disease are the principal means of controlling transmission and reducing incidence. This review presents a historical perspective of active case finding (ACF) of TB, detailing case detection strategies that have been used over the last century. This review is divided into the following sections: mass radiography, house-to-house surveys, out-patient case detection, enhanced case finding, high-risk populations and cost-effectiveness. The report concludes with a discussion and recommendations for future case finding strategies. Understanding the strengths and weaknesses of these methods will help inform and shape ACF as a TB control policy in the twenty-first century.

0 comments Cited 121 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Engaging the private sector to increase tuberculosis case detection: an impact evaluation study.

Aamir Khan, Saira Khowaja, Faisal Khan … (2012)

In many countries with a high burden of tuberculosis, most patients receive treatment in the private sector. We evaluated a multifaceted case-detection strategy in Karachi, Pakistan, targeting the private sector. A year-long communications campaign advised people with 2 weeks or more of productive cough to seek care at one of 54 private family medical clinics or a private hospital that was also a national tuberculosis programme (NTP) reporting centre. Community laypeople participated as screeners, using an interactive algorithm on mobile phones to assess patients and visitors in family-clinic waiting areas and the hospital's outpatient department. Screeners received cash incentives for case detection. Patients with suspected tuberculosis also came directly to the hospital's tuberculosis clinic (self-referrals) or were referred there (referrals). The primary outcome was the change (from 2010 to 2011) in tuberculosis notifications to the NTP in the intervention area compared with that in an adjacent control area. Screeners assessed 388,196 individuals at family clinics and 81,700 at Indus Hospital's outpatient department from January-December, 2011. A total of 2416 tuberculosis cases were detected and notified via the NTP reporting centre at Indus Hospital: 603 through family clinics, 273 through the outpatient department, 1020 from self-referrals, and 520 from referrals. In the intervention area overall, tuberculosis case notification to the NTP increased two times (from 1569 to 3140 cases) from 2010 to 2011--a 2·21 times increase (95% CI 1·93-2·53) relative to the change in number of case notifications in the control area. From 2010 to 2011, pulmonary tuberculosis notifications at Indus Hospital increased by 3·77 times for adults and 7·32 times for children. Novel approaches to tuberculosis case-finding involving the private sector and using laypeople, mobile phone software and incentives, and communication campaigns can substantially increase case notification in dense urban settings. TB REACH, Stop TB Partnership. Copyright © 2012 Elsevier Ltd. All rights reserved.

0 comments Cited 69 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Vishnu Chaturvedi: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 29 November 2016

Publication date Collection: 2016

Volume: 11

Issue: 11

Electronic Location Identifier: e0165813

Affiliations

[1 ]National TB Control Program, Islamabad, Pakistan

[2 ]Centre for International Health, Burnet Institute, Australia

[3 ]Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, India

[4 ]International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India

[5 ]Mott MacDonald, London, United Kingdom

[6 ]Stop TB Partnership, Geneva, Switzerland

[7 ]International Union Against Tuberculosis and Lung Disease, Paris, France

Wadsworth Center, UNITED STATES

Author notes

Competing Interests: Author Robert Stevens is affiliated with Mott MacDonald. Mott MacDonald was contracted by Stop TB (which author Jacob Creswell is affiliated with) to provide independent monitoring and evaluation of TB REACH projects. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Conceptualization: RF EQ AY MUH.
Data curation: RF EQ AY MUH.
Formal analysis: RF EQ AY MUH RS.
Funding acquisition: RF EQ RS JC.
Investigation: RF EQ AY MUH RS.
Methodology: RF EQ AY MUH RS JC.
Project administration: RF EQ AY MUH.
Resources: RF EQ AY MUH RS JC.
Software: RF EQ AY MUH RS.
Supervision: RF EQ.
Validation: RF EQ AY MUH RS.
Visualization: RF EQ AY AMK MUH SSM HDS RS JC NM.
Writing – original draft: RF EQ AY AMK MUH SSM HDS RS JC NM.
Writing – review & editing: RF EQ AY AMK MUH SSM HDS RS JC NM.

* E-mail: aashifa.yaqoob@ 123456gmail.com

Article

Publisher ID: PONE-D-16-24010

DOI: 10.1371/journal.pone.0165813

PMC ID: 5127497

PubMed ID: 27898665

SO-VID: 17cdf07e-e0c2-4e88-a169-0c033da53386

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 15 June 2016

Date accepted : 18 October 2016

Page count

Figures: 2, Tables: 2, Pages: 11

Funding

Funded by: TB Reach Wave III, Stop TB partnership

Award Recipient : Ejaz Qadeer

Mott MacDonald was contracted by Stop TB to provide independent monitoring and evaluation of TB REACH projects. Robert Stevens receives a salary from Mott MacDonald. We gratefully acknowledge the support from the TB REACH secretariat of Stop TB Partnership for funding the study and the Provincial TB Control Programme Pakistan. The specific roles of these authors are articulated in the ‘author contributions’ section. Mott MacDonald contributed professional services and opinion independently of the funder, Stop TB and the grantee, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability The study protocol was reviewed and approved by the Ethics Advisory Group of International Union Against Tuberculosis and Lung Disease (The Union), Paris, France. It will not be possible to share the patient-wise data due to concerns of confidentiality and other ethical restrictions imposed by the advisory group. However, data will be available upon request. Interested researchers may contact “eag@theunion”.

Extending ‘Contact Tracing’ into the Community within a 50-Metre Radius of an Index Tuberculosis Patient Using Xpert MTB/RIF in Urban, Pakistan: Did It Increase Case Detection?

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

PLOS Climate

Most cited references 12

Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial

Active case finding of tuberculosis: historical perspective and future prospects.

Engaging the private sector to increase tuberculosis case detection: an impact evaluation study.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 511

Cited by 17

Most referenced authors 367