Community intervention for child tuberculosis active contact investigation and management: study protocol for a...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health

Background:

• Significant gaps exist in managing pediatric tuberculosis (TB) contact investigations.
• Current facility-based models are insufficient for rapid identification and treatment of active TB in children.
• This study addresses the need for improved TB management in children exposed to bacteriologically confirmed pulmonary TB.

Purpose of the Study:

• To evaluate the impact of a community-based intervention versus a facility-based model for managing children in contact with adults with infectious pulmonary TB.
• To assess the effectiveness of a community-based approach in improving the initiation and completion of TB preventive therapy in pediatric contacts.
• To provide evidence for enhancing childhood TB care and prevention in low-resource, high-burden settings.

Main Methods:

• A multicenter, parallel, open-label, cluster-randomized controlled trial involving 20 clusters in Cameroon and Uganda.
• The community-based intervention included household contact identification, screening, referral, and initiation of preventive therapy by community healthcare workers.
• The primary endpoint was the proportion of eligible child contacts initiating and completing preventive therapy, with 1500 child contacts enrolled.

Main Results:

• The study is designed to identify a 10% difference in the proportion of eligible child contacts initiating and completing preventive therapy between the community-based and facility-based arms.
• The intervention phase involves enrolling index cases and their contacts into either the community- or facility-based models.
• Data analysis will include quantitative and qualitative methods, cost-effectiveness analysis, and post-intervention acceptability assessments.

Conclusions:

• The study is expected to provide crucial evidence on the effectiveness of community-based interventions for childhood TB contact management.
• Findings will inform strategies to improve TB preventive therapy uptake and completion among children in high-burden settings.
• This research aims to enhance the overall care and prevention of childhood tuberculosis globally.