Tuberculosis household accompaniment to improve the contact management cascade: A prospective cohort study

• Published in: PloS one Vol. 14; no. 5; p. e0217104
• Main Authors: Yuen, Courtney M, Millones, Ana K, Contreras, Carmen C, Lecca, Leonid, Becerra, Mercedes C, Keshavjee, Salmaan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.05.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Biology and Life Sciences; Care and treatment; Child; Child, Preschool; Children; Cohort analysis; Confidence intervals; Contact Tracing - statistics & numerical data; Development and progression; Disease prevention; Disease transmission; Drug resistance; Evaluation; Family Characteristics; Female; Health facilities; HIV; Households; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infections; Intervention; Management; Medical diagnosis; Medical research; Medical tests; Medicine and Health Sciences; Methods; Morbidity; Mycobacterium tuberculosis - isolation & purification; Odds Ratio; Patients; People and places; Peru - epidemiology; Population; Prevention; Preventive medicine; Prospective Studies; Radiography; Research and Analysis Methods; Retrospective Studies; Rifamycins; Skin; Skin tests; Therapy; Tuberculin; Tuberculin Test - methods; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - epidemiology; Tuberculosis - prevention & control; Tuberculosis - transmission; Ultrasonic testing; Vouchers; Young Adult; Peru; United States > US; Massachusetts
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0217104

Appropriate management of people exposed in the home to tuberculosis is essential to prevent morbidity. These household contacts, particularly children, should receive preventive therapy to prevent them from falling ill. However, few people receive preventive therapy worldwide. We sought to determine whether a community-based accompaniment intervention could improve tuberculosis contact management. We conducted a prospective cohort study of household contacts of tuberculosis patients who initiated treatment during September 2015-June 2016 in Lima, Peru. Enrolled households received an intervention comprising home visits, transport vouchers, assistance coordinating evaluation procedures, and adherence support during preventive therapy. To evaluate the impact of the intervention, we conducted retrospective chart reviews of all patients initiating treatment during 6-month baseline and intervention periods. We enrolled 314 household contacts of 109 index patients. Of these, 283 (90%) completed evaluation, and 4 (1%) were diagnosed with tuberculosis. Preventive therapy was prescribed for 35/38 (92%) contacts 0-19 years old who were eligible under Peruvian guidelines. Preventive therapy was also prescribed for 6/26 (23%) contacts with unknown eligibility due to lack of a tuberculin skin test (TST), and 20/69 (29%) who were ineligible either because of a negative TST result or exposure to a drug-resistant or extrapulmonary case. Of the 61 contacts who were prescribed preventive therapy, 57 (93%) initiated treatment, and 51 (91%) completed treatment. The proportion of contacts who completed evaluation increased from 42% during the baseline period to 71% during the evaluation period (risk ratio [RR] = 1.73, 95% confidence interval [95% CI]: 1.41-2.13). The proportion of contacts who initiated preventive therapy increased from 15% to 40% (RR = 2.45, 95% CI: 1.42-4.22). Accompaniment of TB patient households greatly improved the evaluation of household contacts for TB and increased the use of preventive therapy.