Supporting tuberculosis program in active contact tracing: a case study from Pakistan

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health

Background:

• Tuberculosis (TB) incidence is increasing in Pakistan, exacerbated by limited treatment access, resource shortages, and social stigma.
• Existing TB control programs face challenges including insufficient treatment sites, a lack of trained personnel, and low active case finding and reporting.
• A significant gap in TB control is the absence of a robust active contact tracing strategy, despite TB's high infectivity.

Purpose of the Study:

• To implement and evaluate a community-based active contact tracing strategy for tuberculosis in Pakistan.
• To assess the effectiveness of enhanced contact investigation in identifying additional TB cases.
• To strengthen TB management capacity through improved diagnostics and treatment accessibility.

Main Methods:

• Community-based active contact tracing was conducted on 17,696 individuals linked to index TB cases in Sindh and Khyber Pakhtunkhwa provinces.
• Supported by USAID's Integrated Health Systems Strengthening and Service Delivery Activity, in collaboration with provincial TB programs.
• Awareness sessions were conducted, and three satellite Programmatic Management of Drug-Resistant Tuberculosis (PMDT) sites were established.

Main Results:

• A total of 243 tuberculosis cases (drug-sensitive and drug-resistant) were diagnosed among the traced contacts.
• The initiative enhanced diagnostic and testing capacity for drug-resistant TB.
• Community engagement through awareness sessions aimed to reduce stigma and promote testing.

Conclusions:

• Community-based active contact tracing is an effective strategy for identifying additional tuberculosis cases, even in resource-limited settings.
• Strengthening TB programs with enhanced contact investigation and improved treatment facilities is vital for controlling the disease burden.
• Addressing systemic bottlenecks and stigma is essential for successful tuberculosis control in Pakistan.