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Open Access Development and testing of models of tuberculosis contact tracing in rural southern Africa

SETTING: A regional hospital in rural Swaziland.

OBJECTIVES: To evaluate a hospital-based contact screening programme and test approaches to improve its effectiveness.

DESIGN: An evaluation and quality improvement study of tuberculosis (TB) contact tracing services.

RESULTS: Hospital-based TB contact tracing led to screening of 157 (24%) of 658 contacts; of these, 4 (2.5%) were diagnosed with TB. Of 68 contacts eligible for human immunodeficiency virus (HIV) testing and counselling, 45 (66%) were tested and 7/45 (16%) were identified as HIV-positive. Twelve (50%) of 24 screened contacts aged <5 years were provided isoniazid prophylaxis. Three enhanced models of TB contact tracing were piloted to screen contacts in the community. Although some enhanced models screened large numbers of contacts, no contacts were diagnosed with TB.

CONCLUSION: Contact tracing of household members conducted in TB clinics within hospital settings is effective in high-burden, low-income settings, and can be provided using current resources. Enhanced household contact tracing models that followed up contacts in the community were not found to be effective. Additional resources would be required to provide household TB contact tracing in the community.

Keywords: Swaziland; contact tracing; poverty; rural health; tuberculosis

Document Type: Research Article

Affiliations: 1: Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK 2: London Deanery, London, UK 3: Yorkshire and the Humber Deanery, University of Leeds, Leeds, UK 4: Good Shepherd Hospital, Siteki, Swaziland 5: Matsapha Health Care, Matsapha, Swaziland 6: Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK

Publication date: December 21, 2013

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