Active household contact screening for tuberculosis and provision of isoniazid preventive therapy to under-five children in Afghanistan

Sayedi, Said Mirza; Seddiq, Mohammad Khaled; Rashidi, Mohammad Khakerah; Qader, Ghulam Qader; Ikram, Naser; Melese, Muluken; Suarez, Pedro

doi:10.1371/journal.pone.0240031

Cited by 10 publications

(13 citation statements)

References 15 publications

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“…Collecting data from the programme registers and from reports that lack rigour in documenting the information could lead to selection bias for the number of household contacts. [32,38,52,53,62] Adherence to TPT The common factors related to TPT adherence included: higher cost of transportation, medication palatability, longer treatment duration, social support, and the knowledge and beliefs of HCWs and carers. Further, treatment adherence reported in the studies could be an overestimation as it depended on pill count or on the monthly collection of prescriptions.…”

Section: Inadequate Documentationmentioning

confidence: 99%

Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries ‐ a systematic review and meta‐analysis

Sagili¹,

Muniyandi

Shringarpure

et al. 2022

Tropical Med Int Health

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Objective To summarise latent tuberculosis infection (LTBI) management strategies among household contacts of bacteriologically confirmed pulmonary tuberculosis (TB) patients in high‐TB burden countries. Methods PubMed/MEDLINE (NCBI) and Scopus were searched (January 2006 to December 2021) for studies reporting primary data on LTBI management. Study selection, data management and data synthesis were protocol‐driven (PROSPERO‐CRD42021208715). Primary outcomes were the proportions of LTBI, initiating and completing tuberculosis preventive treatment (TPT). Reported factors influencing the LTBI care cascade were qualitatively synthesised. Results From 3694 unique records retrieved, 58 studies from 23 countries were included. Most identified contacts were screened (median 99%, interquartile range [IQR] 82%–100%; 46 studies). Random‐effects meta‐analysis yielded pooled proportions for: LTBI 41% (95% confidence interval [CI] 33%–49%; 21,566 tested contacts); TPT initiation 91% (95% CI 79%–97%; 129,573 eligible contacts, 34 studies); TPT completion 65% (95% CI 54%–74%; 108,679 TPT‐initiated contacts, 28 studies). Heterogeneity was significant (I2 ≥ 95%–100%) and could not be explained in subgroup analyses. Median proportions (IQR) were: LTBI 44% (28%–59%); TPT initiation 86% (60%–100%); TPT completion 68% (44%–82%). Nine broad themes related to diagnostic testing, health system structure and functions, risk perception, documentation and adherence were considered likely to influence the LTBI care cascade. Conclusion The proportions of household contacts screened, detected with LTBI and initiated on TPT, though variable was high, but the proportions completing TPT were lower indicating current strategies used for LTBI management in high TB burden countries are not sufficient.

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Section: Inadequate Documentationmentioning

confidence: 99%

Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries ‐ a systematic review and meta‐analysis

Sagili¹,

Muniyandi

Shringarpure

et al. 2022

Tropical Med Int Health

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“…Our estimate of this latter quantity (based on the estimated case notification ratio for all children with active TB [14] ) may be overestimated for countries with poor existing implementation of household contact investigation implementation. Similarly, we may have overestimated IPT coverage among pediatric household contacts, as the registered numbers of pediatric contacts eligible for TB preventive treatment [13] were much lower than the estimated total numbers of child contacts with TB infection based on TB prevalence and demographic surveillance data [15] . Accordingly, our model-based estimates of cost-effectiveness are likely conservative.…”

Section: Discussionmentioning

confidence: 93%

“…These estimates, coupled with data from the scientific literature [9] , enabled us to project the number of future TB cases and deaths due to reactivation of TB infection that would be experienced by child contacts with LTBI at the time of potential household contact investigation. Based on published cohort studies [10] , [11] , [12] , [13] , we assumed that 37% of pediatric contacts would have symptoms (such as poor appetite, chronic cough, weight loss, fever, night sweats) at the time of potential household contact investigation, and would all be evaluated for active TB with sputum Xpert testing. We assumed that diagnostic testing plus clinician decision-making would have 65% sensitivity and 90% specificity for the diagnosis of active TB among pediatric household contacts [14] , using wide ranges for sensitivity analysis.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of scaling up short course preventive therapy for tuberculosis among children across 12 countries

Gomes

Flack

et al. 2021

EClinicalMedicine

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Background While household contact investigation is widely recommended as a means to reduce the burden of tuberculosis (TB) among children, only 27% of eligible pediatric household contacts globally received preventive treatment in 2018. We assessed the cost-effectiveness of household contact investigation for TB treatment and short-course preventive therapy provision for children under 15 years old across 12 high TB burden countries. Methods We used decision analysis to compare the costs and estimated effectiveness of three intervention scenarios: (a) status quo (existing levels of coverage with isoniazid preventive therapy), (b) contact investigation with treatment of active TB but no additional preventive therapy, and (c) contact investigation with TB treatment and provision of short-course preventive therapy. Using country-specific demographic, epidemiological and cost data from the literature, we estimated annual costs (in 2018 USD) and the number of TB cases and deaths averted across 12 countries. Incremental cost effectiveness ratios were assessed as cost per death and per disability-adjusted life year [DALY] averted. Findings Our model estimates that contact investigation with treatment of active TB and provision of preventive therapy could be highly cost-effective compared to the status quo (ranging from $100 per DALY averted in Malawi to $1,600 in Brazil; weighted average $383 per DALY averted [uncertainty range: $248 – $1,130]) and preferred to contact investigation without preventive therapy (weighted average $751 per DALY averted [uncertainty range: $250 – $1,306]). Key drivers of cost-effectiveness were TB prevalence, sensitivity of TB diagnosis, case fatality for untreated TB, and cost of household screening. Interpretation Based on this modeling analysis of available published data, household contact investigation with provision of short-course preventive therapy for TB has a value-for-money profile that compares favorably with other interventions. Funding Unitaid (2017–20-IMPAACT4TB).

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“…Moreover, the social, mental and economic burden of undiagnosed cases is catastrophic for the families [ 19 ]. There is enough evidence available that active contact tracing can limit the transmission of tuberculosis and has been much more successful than any other TB control intervention [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

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

Shaikh¹,

Laghari²,

Durrani³

et al. 2022

Infect Dis Poverty

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Tuberculosis (TB) is on the rise in Pakistan and there could be multiple reasons including poverty, difficulty in access to TB treatment services, non-compliance with treatment, social stigma etc. According to the TB program managers, limited treatment and testing sites for tuberculosis and lack of trained human resources play a major role in compromising TB management. A major lacuna in the TB control program is the absence of active contact tracing strategy. This is essential for a disease where positive cases are known to be able to infect a further 10‒15 individuals in a year. Tackling tuberculosis in Pakistan has been beleaguered by funding challenges and other systems’ bottlenecks such as lack of skilled human resources and insufficient supply of medicines, despite the fact that disease burden is one of the highest in the world. Although it is a notifiable disease, active case finding, contact tracing and reporting is notoriously low throughout the country. Access to diagnostics and treatment facilities has been limited and stigma attached to the disease remains deeply entrenched among the communities. Researchers have shown that enhanced and active approaches to contact investigation effectively identifies additional patients with TB among household contacts at a relatively modest cost. USAID’s Integrated Health Systems Strengthening and Service Delivery Activity extended support to the Health Departments of Sindh and Khyber Pakhtunkhwa provinces. In collaboration with the two provincial TB programs, community based active contact tracing was conducted on 17,696 individuals, based on the index cases. Among the contacts traced, 243 cases were diagnosed as drug sensitive or drug resistant TB. Awareness sessions were conducted to sensitize people on the various aspects of disease and importance of getting tested. The project also supported establishing three satellite Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites for drug resistant TB treatment, enhancing the programs’ diagnostic and testing capacity.

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Active household contact screening for tuberculosis and provision of isoniazid preventive therapy to under-five children in Afghanistan

Cited by 10 publications

References 15 publications

Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries ‐ a systematic review and meta‐analysis

Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries ‐ a systematic review and meta‐analysis

Cost-effectiveness of scaling up short course preventive therapy for tuberculosis among children across 12 countries

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

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