Tuberculosis Contact Investigation Policies, Practices, and Challenges in 11 U.S. Communities

Abstract

To describe the policies and procedures used by 11 urban tuberculosis control programs to conduct contact investigations, written policies were reviewed and semi-structured interviews were conducted with program managers and staff. Qualitative analysis showed that contact investigation policies and procedures vary widely. Most policies address risk factor assessment and contact prioritization; however, none of the policies provide comprehensive guidance for the entire process. Staffing patterns vary, but, overall, staff receive little formal training; informal monitoring practices predominate. Comprehensive guidelines and programmatic support are needed to improve the quality of contact investigation processes.

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

“…Few studies, however, provided data regarding these indicators. Wilce et al 113 highlighted the variability in accuracy of information recorded and the need for improvement in this area. Only one paper 97 referred to awareness raising as an outcome from an investigation.…”

“…105 Others concluded that the screening of casual contacts was not cost-effective in low incidence areas, 38 should be carried out only for smear-positive respiratory index cases 102 or only for highly infectious cases, 33 or that there should be only limited screening of casual contacts. 87 The authors of one study 113 found that the 39 defined a close contact as someone having < 4 hours' exposure indoors or in a confined space, and a casual contact as someone with exposure other than close. Another study 42 defined people who spent an estimated total of at least 40-100 hours with the index cases in the 3 months prior to diagnosis or during the infectious period as 'close contacts', and those who shared the same front door as the index case as 'household contacts'.…”

“…The authors reported that, as TB rates were historically low in the area, no specialised/experienced team was available to conduct contact tracing. Wilce et al 113 found variability in levels of training received by staff involved in investigations. A qualitative study exploring the perceptions of patients with active TB and staff involved in contact investigations concluded that programmes may be enhanced by staff receiving training in listening and culturally appropriate interviewing techniques.…”

“…1 in interviewing techniques was echoed in a second study 61 and further supported by Bock et al, 43 who described how patients who were reinterviewed by 'experienced interviewers' named an additional 282 contacts who had not been identified in the first interview. Wilce et al 113 described how, in one investigation, the content of the interview was typically left to the discretion of the interviewer.…”

“…34 However, the included literature contained many references to inconsistency in use of guidelines, and a requirement for training and support to improve adherence and thereby increase the standard of contact-tracing investigations. 53,84,95,100,113 One study found inconsistent and limited recording of the data collected, and differences between who was selected for screening and who was used as the primary source of information. 53 Researchers who retrospectively analysed a TB data registry for children found limited documentation regarding the labelling of the level of closeness of contact among those screened.…”