Improving child tuberculosis contact identification and screening in Lesotho: Results from a mixed-methods...

Area of Science:

• Public Health
• Implementation Science
• Infectious Disease Epidemiology

Background:

• Child tuberculosis (TB) contact management is crucial for prevention but often suboptimal in high TB/HIV settings.
• The PREVENT Study addressed implementation challenges in Lesotho, a high TB burden country.
• Child TB prevention requires effective strategies to identify and manage contacts.

Purpose of the Study:

• To evaluate the effectiveness and acceptability of a community-based intervention (CBI) to improve child TB contact management.
• To assess barriers and facilitators to child TB contact management in a high-burden setting.
• To compare CBI with standard of care (SOC) for child TB contact identification and screening.

Main Methods:

• A clustered-randomized implementation study involving 10 health facilities in Lesotho.
• Comparison of CBI with SOC, with data abstracted from TB registers and patient cards.
• Mixed-methods approach using quantitative data for outcomes and qualitative interviews for acceptability.

Main Results:

• Contact yield per TB case was marginally higher in the CBI arm (0.40) versus SOC (0.20).
• Screening proportions were similar between arms (94% vs. 62%).
• The CBI was found to be acceptable to both healthcare providers and caregivers.

Conclusions:

• While identification and screening were similar, CBI showed a higher yield of child TB contacts.
• Community-based interventions hold potential for improving child TB prevention.
• Scaling up CBI may enhance engagement with child TB contacts and contribute to TB elimination efforts.