Programmatic Implementation of Contact Investigation in Eight African Countries

Abstract

The objective was to implement CI under national tuberculosis programmatic conditions and to advocate for its scaling up. Contact investigation was implemented in 150 Basic Management Units identified across eight countries. The target populations (children <5 years and persons living with HIV (PLHIV)) were evaluated during home and clinic visits using standardized tools, clinical examinations and, according to each country, additional tests. Contacts with active TB received TB treatment and those eligible received TB preventive therapy (TPT). Data were collected each quarter using standardized forms. Meetings were organized with partners to share preliminary results and advocate for scaling up. From October 2020 to December 2021, 9049 home visits were performed. The proportions of children <5 years and PLHIV who were screened and diagnosed with active TB were, respectively, 2.6% and 10.1%. Ninety-three percent of children <5 years and 98% of PLHIV living at home received TPT or TB treatment, respectively. The scale-up for contact investigation partially or at national level in 2022 was effective in six of the eight countries included in the project. These results indicate that CI is feasible under programmatic conditions within the National TB Programs of African countries.

Keywords: Africa; PLHIV; TB preventive therapy; TB treatment; children under 5; contact investigation; programmatic conditions.

Figure 1

Countries with study sites included in this paper.

Figure 2

Screening algorithm used for children under 5 years. * the following additional tests: (1) Chest X-Ray; (2) Sputum specimens for Smear and/or Xpert MTB/RIF depending on the country.

Figure 3

Screening algorithm used for adults and adolescents. * the following additional tests: (1) Chest X-Ray; (2) Sputum specimens for Smear and/or Xpert MTB/RIF depending on the country.