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Free Content A home tracing program for contacts of people with tuberculosis or HIV and patients lost to care

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SETTING:

Primary care clinic serving a high tuberculosis (TB) and human immunodeficiency virus (HIV) prevalence community in South Africa.

OBJECTIVE:

To evaluate a program combining TB and HIV contact investigation with tracing of individuals lost to TB or HIV care.

DESIGN:

Contacts were offered home-based HIV testing, TB symptom screening, sputum collection and referral for isoniazid preventive therapy (IPT). Effectiveness was assessed by the number needed to trace (NNT).

RESULTS:

Only 419/1197 (35.0%) households were successfully traced. Among 267 contacts, we diagnosed 27 new HIV cases (10 linked to care) and two TB cases (both initiated treatment) and three started IPT. Of 630 patients lost to care, 132 (21.0%) were successfully traced and 81 (61.4%) re-engaged in care. The NNT to locate one individual lost to care was 4.8 (95%CI 4.1–5.6), to re-engage one person in care 7.8 (95%CI 6.4–9.7), to diagnose one contact with HIV 44.3 (95%CI 30.6–67.0), to link one newly diagnosed contact to HIV care 120 (95%CI 65.3–249.2) and to find one contact with active TB and initiate treatment 599 (95%CI 166.0–4940.7).

CONCLUSION:

The effectiveness of this contact tracing approach in identifying new TB and HIV cases was low. Methods to optimize contact investigation should be explored and their cost-effectiveness assessed.
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Keywords: South Africa; human immunodeficiency virus; intensified case finding; tuberculosis

Document Type: Research Article

Affiliations: 1: Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa 2: University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA 3: Witkoppen Health and Welfare Center, Johannesburg, South Africa

Publication date: May 1, 2014

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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