Interventions to improve contact tracing for tuberculosis in specific groups and in wider populations: an evidence synthesis

Abstract

BackgroundThe tracing and screening of people who have had contact with an active case of tuberculosis (TB) is an important element of TB control strategies.ObjectivesThis study aimed to carry out a review of evidence regarding TB contact tracing, with a particular emphasis on research that was applicable to TB contact tracing in specific population groups in the UK.DesignAn evidence synthesis of literature of any study design on TB contact tracing in developed countries was carried out.SettingAny setting.PopulationIndividuals found to have active TB disease, and people who have come into contact with them.InterventionsContact-tracing investigations.Main outcome measuresAny outcome related to TB infection, contact investigations and/or the views of staff, people with TB disease, or their contacts.Data sourcesSearches for research published 1995 onwards were undertaken in the following databases: MEDLINE via Ovid SP, EMBASE via Ovid SP, EconLit via Ovid SP, PsycINFO via Ovid SP, Social Policy and Practice via Ovid SP, Cumulative Index to Nursing and Allied Health Literature via EBSCOhost, Science and Social Science Citation Indices via Web of Science and The Cochrane Library via Wiley Online Library.Review methodsThe study comprised a review of TB contact tracing in specific population groups and a review in wider populations. A narrative synthesis was completed and a logic model was developed from the literature.ResultsThere were 112 articles in the review: 23 related to specific populations and 89 related to wider populations. The literature was of limited quality, with much general description of investigations. We identified only two (uncontrolled) studies that could be considered evaluative. Although the limitations of the evidence should be recognised, the review suggested the following: the value of a location-based approach, working with local communities and the media, partnership working, using molecular epidemiological testing, ensuring adequate systems and addressing fear of stigma. The literature on investigations for specific populations has much concordance with that reporting findings from wider population groups. The recognised limitations of conventional investigation methods may, however, be exacerbated in specific populations.LimitationsThe English-language inclusion criterion may have limited the breadth of countries represented. A meta-analysis was not possible owing to the nature of the literature. Relevant studies may have been missed by our searches, which used terminology relating to contact tracing rather than to active case finding or screening.ConclusionsThe review identified a sizeable volume of literature relating to contact investigations. However, it is currently predominantly descriptive, with little evaluative work underpinning investigations in either specific or wider populations. Our findings are, therefore, based on limited evidence. Further research is required if robust conclusions are to be made.Future workResearch should further explore the development of measures that can be used to compare the effectiveness of different contact investigations, in studies using evaluative designs.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

“…After screening 2943 titles and abstracts and 271 full-text articles, 73 unique articles fulfilled our eligibility criteria (figure 1). 14–86 The reasons for excluding full-text articles are provided in figure 1. What all included studies have in common is the goal of finding ‘missing’ TB cases through ACF, while the approaches vary greatly; from contact investigation to screening people in homeless shelters (table 1).…”

“…In resource poor settings, ACF is often backed by multichannel financing mechanisms, including from international donors 26. Record-keeping, monitoring and evaluation are described as being essential 27 28. Incentives are sometimes deemed necessary, for example, for health workers,5 29 laboratory technicians,30 screening participants11 31–35 and TB patients 29 35 36.…”

“…Finally, the studies underlined how vital it is to collaborate with other disease programmes,33 34 43 agencies and sectors26 27 and to integrate ACF within existing systems 18 44. The latter includes collaboration between providers and community-based organisations,43 and between HIV and TB services 45…”

“…Nineteen percent (n=8/43) of the articles elaborated on the availability of diagnostic tests and services as key influencing factor for ACF policy implementation—with many articles referring to the availability of molecular diagnostic tests such as Xpert MTB/RIF 27 36 49 50. Decentralisation of healthcare services, national coverage of diagnostics and task sharing were perceived as facilitators of ACF policy implementation, but unavailable in many settings 33…”

Summary of the COVID-19 outbreak in Vietnam – Lessons and suggestions

“…Therefore, the Vietnamese government may consider a combination of strict self-quarantine in the community and use of new technology, such as application of big data and artificial intelligence to improve contact tracing and the management of potentially infected patients. It may aid in reducing person-to-person spread [5]. In addition to vigorous control strategies, studies on individual patient epidemiological data are needed, which would enable epidemiologists to build a model of the outbreak and determine the number of new infections triggered by each case.…”