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. 2019 Jul 29;5(3):00112-2019.
doi: 10.1183/23120541.00112-2019. eCollection 2019 Jul.

Home-based tuberculosis contact investigation in Uganda: a household randomised trial

J Lucian Davis  1   2   3 , Patricia Turimumahoro  3 , Amanda J Meyer  1   3 , Irene Ayakaka  3 , Emma Ochom  3 , Joseph Ggita  3 , David Mark  3 , Diana Babirye  3 , Daniel Ayen Okello  4 , Frank Mugabe  5 , Elizabeth Fair  6   7 , Eric Vittinghoff  8 , Mari Armstrong-Hough  1   3 , David Dowdy  3   9 , Adithya Cattamanchi  3   6   7 , Jessica E Haberer  10 , Achilles Katamba  3   11
Affiliations

Home-based tuberculosis contact investigation in Uganda: a household randomised trial

J Lucian Davis et al. ERJ Open Res. .

Abstract

Introduction: The World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries, but most contacts do not complete a full clinical and laboratory evaluation.

Methods: We performed a randomised trial of home-based, SMS-facilitated, household TB contact investigation in Kampala, Uganda. Community health workers (CHWs) visited homes of index patients with pulmonary TB to screen household contacts for TB. Entire households were randomly allocated to clinic (standard-of-care) or home (intervention) evaluation. In the intervention arm, CHWs offered HIV testing to adults; collected sputum from symptomatic contacts and persons living with HIV (PLWHs) if ≥5 years; and transported sputum for microbiologic testing. CHWs referred PLWHs, children <5 years, and anyone unable to complete sputum testing to clinic. Sputum testing results and/or follow-up instructions were returned by automated SMS texts. The primary outcome was completion of a full TB evaluation within 14 days; secondary outcomes were TB and HIV diagnoses and treatments among screened contacts.

Results: There were 471 contacts of 190 index patients allocated to the intervention and 448 contacts of 182 index patients allocated to the standard-of-care. CHWs identified 190/471 (40%) intervention and 213/448 (48%) standard-of-care contacts requiring TB evaluation. In the intervention arm, CHWs obtained sputum from 35/91 (39%) of sputum-eligible contacts and SMSs were sent to 95/190 (50%). Completion of TB evaluation in the intervention and standard-of-care arms at 14 days (14% versus 15%; difference -1%, 95% CI -9% to 7%, p=0.81) and yields of confirmed TB (1.5% versus 1.1%, p=0.62) and new HIV (2.0% versus 1.8%, p=0.90) diagnoses were similar.

Conclusions: Home-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation, likely due to challenges delivering the intervention components.

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Conflict of interest statement

Conflict of interest: J.L. Davis reports grants from National Institute of Allergy and Infectious Diseases, and the Fogarty International Center during the conduct of the study. Conflict of interest: P. Turimumahoro has nothing to disclose. Conflict of interest: A.J. Meyer has nothing to disclose. Conflict of interest: I. Ayakaka has nothing to disclose. Conflict of interest: E. Ochom has nothing to disclose. Conflict of interest: J. Ggita has nothing to disclose. Conflict of interest: D. Mark has nothing to disclose. Conflict of interest: D. Babirye has nothing to disclose. Conflict of interest: D.A. Okello has nothing to disclose. Conflict of interest: F. Mugabe has nothing to disclose. Conflict of interest: E. Fair has nothing to disclose. Conflict of interest: E. Vittinghoff reports salary support for statistical analysis from the NIH during the conduct of the study. Conflict of interest: M. Armstrong-Hough reports grants from National Institutes of Health during the conduct of the study. Conflict of interest: D. Dowdy has nothing to disclose. Conflict of interest: A. Cattamanchi has nothing to disclose. Conflict of interest: J.E. Haberer reports grants from the NIH during the conduct of the study; and personal fees for consultation from Merck, and grants from USAID and the Gates Foundation, outside the submitted work. Conflict of interest: A. Katamba has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
CONSORT flow diagram describing enrolment of household contacts. TB: tuberculosis.
FIGURE 2
FIGURE 2
Cumulative incidence of eligible household contacts completing tuberculosis evaluation from the time of enrolment, stratified by allocation arm.
See this image and copyright information in PMC

References

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