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Tuberculosis screening in household contacts of pulmonary tuberculosis patients in an urban setting
Banurekha Velayutham1, Lavanya Jayabal2, Basilea Watson1
1ICMR- National Institute for Research in Tuberculosis, Chennai, India.
Insights
The "Household contact card and register" effectively screens household contacts (HHC) of pulmonary tuberculosis (PTB) patients, improving detection rates. Addressing barriers to screening and follow-up is crucial for tuberculosis control.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Tuberculosis Control
Background:
- Household contacts (HHC) of tuberculosis (TB) patients face a significant risk of TB infection and disease.
- Effective screening strategies for HHC are essential for early detection and prevention of TB transmission.
Purpose of the Study:
- To assess the utility of the "Household contact card and register" tool for screening HHC of pulmonary TB (PTB) patients.
- To identify reasons for HHC not being screened or followed up for TB.
Main Methods:
- Implementation of the "Household contact card and register" by Health Care Workers (HCW) for PTB HHC screening.
- Screening within 2 months of index PTB patient treatment initiation, including symptom assessment, radiography, and sputum examination.
- Comparison of HHC screening rates pre- and post-implementation, with 6 and 12-month follow-up assessments.
Main Results:
- HHC information documented for 93% of index PTB patients; 80% of contacts were screened for TB.
- Key reasons for non-screening included inconvenient timing, perceived good health, stigma, and travel.
- TB treatment initiated in 21 contacts; preventive therapy in 59% of contacts aged <6 years; screening improved from 36% to 80%.
Conclusions:
- The "Household contact card and register" is a valuable tool for HCWs in TB screening among PTB HHC.
- Addressing barriers to contact screening adherence is critical for successful TB control programs.
Background:
Household contacts (HHC) of tuberculosis (TB) patients are at risk of TB infection and disease. The study assessed the utility of "Household contact card and register" for screening of HHC of pulmonary TB (PTB) patients for TB and explored the reasons for HHC not being screened and followed-up.
Methods:
The "Household contact card and register" was implemented by the Health Care Workers (HCW) of the TB Control Programme in Chennai District for screening HHC of index PTB patients initiated on treatment between June and August, 2018. Contacts were required to be screened within 2 months of treatment initiation of the index patient. Details collected included age, gender, smoking, alcohol use, immunosuppressive conditions and TB treatment. Symptom screening along with chest radiograph and or sputum examination was attempted. Follow-up TB screening at 6 and 12 months were performed. Screening of HHC was compared pre and post implementation phase. Proportions were computed for the data analysed.
Results:
HHC information was documented for 93% (1268/1364) of Index PTB patients. The main reasons of non-listing of HHC in 96 PTB patients were HCW non-availability or non-co-operation of the HHC. There were 2150 (80%) contacts who were screened for TB. Inconvenient time, feeling healthy, stigma, out-station visit were the main reasons for 537 contacts not undergoing TB screening. Anti-TB treatment was initiated in 21 (1%) of contacts diagnosed with TB. Preventive therapy was initiated in 59% (81/138) of contacts aged <6 years. The screening of HHC improved from 36% to 80% during the implementation phase. Follow-up TB screening at 12 months was performed in 50% of HHC and 2 incident TB cases were identified.
Conclusion:
"Household contact card and register" is a useful tool for HCWs for TB screening in HHC of PTB patients. Reasons for non-adherence to contact screening needs to be addressed.
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