TY - JOUR
T1 - Active contact investigation and treatment support
T2 - An integrated approach in rural and urban Sindh, Pakistan
AU - Shah, S. A.
AU - Qayyum, S.
AU - Abro, R.
AU - Baig, S.
AU - Creswell, Jacob
PY - 2013/12/1
Y1 - 2013/12/1
N2 - BACKGROUND: Although household contacts of persons with tuberculosis (TB) have high rates of active TB, contact investigations are often not conducted. We present the results from a large-scale active contact investigation combined with treatment support in Sindh, Pakistan. METHODS: Trained lay workers visited consenting smear-positive index patient homes in seven urban and 15 rural facilities. People with suspected TB were provided free transport to diagnostic centres, and sputum samples were collected for microscopy. Those diagnosed with smear-positive TB were given food baskets and sent text reminders to promote adherence. RESULTS: From 3037 index cases, 19 191 household contacts were screened for TB symptoms and 3478 (18.1%) symptomatic persons were identified. Of these, 2160 (62.1%) produced sputum samples on the spot for testing and 490 (22.7%) had smear-positive results. TB prevalence in urban households was 1504 per 100 000 population compared to 4044/100 000 in rural households (P < 0.001) and 2553/100 000 overall. Treatment success was high, with 80.4% cured and 17.6% completing treatment. DISCUSSION: Lay workers given basic training can conduct active contact investigations and provide treatment support to improve case detection and treatment outcomes in urban and rural areas of Pakistan. In areas with high levels of undiagnosed TB, particularly in rural areas, contact investigation should be prioritised as a means of improving case detection and early diagnosis.
AB - BACKGROUND: Although household contacts of persons with tuberculosis (TB) have high rates of active TB, contact investigations are often not conducted. We present the results from a large-scale active contact investigation combined with treatment support in Sindh, Pakistan. METHODS: Trained lay workers visited consenting smear-positive index patient homes in seven urban and 15 rural facilities. People with suspected TB were provided free transport to diagnostic centres, and sputum samples were collected for microscopy. Those diagnosed with smear-positive TB were given food baskets and sent text reminders to promote adherence. RESULTS: From 3037 index cases, 19 191 household contacts were screened for TB symptoms and 3478 (18.1%) symptomatic persons were identified. Of these, 2160 (62.1%) produced sputum samples on the spot for testing and 490 (22.7%) had smear-positive results. TB prevalence in urban households was 1504 per 100 000 population compared to 4044/100 000 in rural households (P < 0.001) and 2553/100 000 overall. Treatment success was high, with 80.4% cured and 17.6% completing treatment. DISCUSSION: Lay workers given basic training can conduct active contact investigations and provide treatment support to improve case detection and treatment outcomes in urban and rural areas of Pakistan. In areas with high levels of undiagnosed TB, particularly in rural areas, contact investigation should be prioritised as a means of improving case detection and early diagnosis.
KW - Active case finding
KW - Contact investigation
KW - Incentives
KW - Treatment support
UR - http://www.scopus.com/inward/record.url?scp=84888112313&partnerID=8YFLogxK
U2 - 10.5588/ijtld.13.0169
DO - 10.5588/ijtld.13.0169
M3 - Article
C2 - 24200270
AN - SCOPUS:84888112313
SN - 1027-3719
VL - 17
SP - 1569-1574+i
JO - International Journal of Tuberculosis and Lung Disease
JF - International Journal of Tuberculosis and Lung Disease
IS - 12
ER -