Home-based tuberculosis contact investigation in Uganda: a household randomised trial
J Lucian Davis1,2,3, Patricia Turimumahoro3, Amanda J Meyer1,3
1Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
ERJ Open Research
|August 2, 2019
Summary
A home-based, SMS-facilitated tuberculosis (TB) contact investigation did not improve evaluation completion rates. This strategy, aimed at enhancing TB case finding in low-income settings, showed similar results to standard care.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Global Health
Background:
- The World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries.
- However, a significant proportion of contacts fail to complete full clinical and laboratory evaluations, hindering effective TB control.
Purpose of the Study:
- To evaluate the effectiveness of a home-based, SMS-facilitated TB contact investigation strategy.
- To compare this intervention with standard-of-care clinic-based evaluations in Kampala, Uganda.
Main Methods:
- A randomized trial was conducted involving household contacts of index TB patients.
- The intervention group received home-based evaluation facilitated by community health workers (CHWs) using SMS for result delivery.
- The control group received standard-of-care clinic-based evaluation.
Main Results:
- Completion of TB evaluation within 14 days was similar between the intervention (14%) and standard-of-care (15%) arms.
- The yield of confirmed TB diagnoses (1.5% vs. 1.1%) and new HIV diagnoses (2.0% vs. 1.8%) was also comparable between the groups.
- Challenges in delivering intervention components likely impacted outcomes.
Conclusions:
- Home-based, SMS-facilitated TB contact investigation did not significantly improve evaluation completion or diagnostic yield.
- Further research is needed to overcome implementation challenges for similar interventions in resource-limited settings.
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