Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi
Issued Date
2022-09-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85137656540
Pubmed ID
36074775
Journal Title
PLoS ONE
Volume
17
Issue
9 September
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.17 No.9 September (2022)
Suggested Citation
Kaswaswa K., MacPherson P., Kumwenda M., Mpunga J., Thindwa D., Nliwasa M., Mwapasa M., Odland J., Tomoka T., Chipungu G., Mukaka M., Corbett E.L. Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi. PLoS ONE Vol.17 No.9 September (2022). doi:10.1371/journal.pone.0269219 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86479
Title
Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi
Author's Affiliation
Kamuzu University of Health Sciences
Faculty of Tropical Medicine, Mahidol University
Malawi-Liverpool-Wellcome Trust Clinical Research Programme
London School of Hygiene & Tropical Medicine
UiT Norges Arktiske Universitet
Liverpool School of Tropical Medicine
Nuffield Department of Medicine
Malawi National TB Control Programme
Faculty of Tropical Medicine, Mahidol University
Malawi-Liverpool-Wellcome Trust Clinical Research Programme
London School of Hygiene & Tropical Medicine
UiT Norges Arktiske Universitet
Liverpool School of Tropical Medicine
Nuffield Department of Medicine
Malawi National TB Control Programme
Other Contributor(s)
Abstract
Background Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to improve uptake. Methods Between May and December 2014, we randomised patient with TB who consented to participate in the trial to either standard of care (SOC) or intervention (PACTS) arms. Participants randomised to PACTS received one screening/triage tool (adapted from WHO integrated management of adolescent and adult illnesses [IMAI] guidelines) and sputum pots for each reported household contact. The tool guided participants through symptom screening; TPT (6-months of isoniazid) eligibility; and sputum collection for contacts. Patients randomised to SOC were managed in accordance with national guidelines, that is, they received verbal instruction on who to bring to clinics for investigation using national guidelines. Main outcome and measures The primary outcome was the proportion of adult contacts receiving treatment for TB within 3 months of randomisation. Secondary outcomes were the proportions of child contacts under age 5 years (U5Y) who were commenced on, and completed, TPT. Data were analyzed by logistic regression with random effects to adjust for household clustering. Results Two hundred and fourteen index TB participants were block-randomized from two sites (107 PACTS, reporting 418 contacts; and 107 SOC, reporting 420 contacts). Overall, 62.8% of index TB participants were HIV-positive and 52.1% were TB culture-positive. 250 otherwise eligible TB patients declined participation and 6 households (10 PACTS, 6 SOC) were lost to follow-up and were not included in the analysis. By three months, nine contacts (PACTS: 6, [1.4%]; SOC: 3, [0.7%]) had TB diagnosed, with no difference between groups (adjusted odds ratio [aOR]: 2.18, 95% CI: 0.60-7.95). Eligible PACTS contacts (37/96, 38.5%) were more likely to initiate TPT by 3-months compared to SOC contacts (27/101, 26.7%; aOR 2.27, 95% CI: 1.04-4.98). U5Y children in the PACTS arm (47/81 58.0%) were more likely to have initiated TPT before the 3-month visit compared to SOC children (36/89, 41.4%; aOR: 2.31, 95% CI: 1.05-5.06). Conclusions and relevance A household-centred patient-delivered symptom screen and IPT eligibility assessment significantly increased timely TPT uptake among U5Y children, but did not significantly increase TB diagnosis. This model needs to be optimized for acceptability, given low participation, and investigated in other low resource settings.