Abstract
Introduction The World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries, but most contacts do not complete a full clinical and laboratory evaluation.
Methods We performed a randomised trial of home-based, SMS-facilitated, household TB contact investigation in Kampala, Uganda. Community health workers (CHWs) visited homes of index patients with pulmonary TB to screen household contacts for TB. Entire households were randomly allocated to clinic (standard-of-care) or home (intervention) evaluation. In the intervention arm, CHWs offered HIV testing to adults; collected sputum from symptomatic contacts and persons living with HIV (PLWHs) if ≥5 years; and transported sputum for microbiologic testing. CHWs referred PLWHs, children <5 years, and anyone unable to complete sputum testing to clinic. Sputum testing results and/or follow-up instructions were returned by automated SMS texts. The primary outcome was completion of a full TB evaluation within 14 days; secondary outcomes were TB and HIV diagnoses and treatments among screened contacts.
Results There were 471 contacts of 190 index patients allocated to the intervention and 448 contacts of 182 index patients allocated to the standard-of-care. CHWs identified 190/471 (40%) intervention and 213/448 (48%) standard-of-care contacts requiring TB evaluation. In the intervention arm, CHWs obtained sputum from 35/91 (39%) of sputum-eligible contacts and SMSs were sent to 95/190 (50%). Completion of TB evaluation in the intervention and standard-of-care arms at 14 days (14% versus 15%; difference −1%, 95% CI −9% to 7%, p=0.81) and yields of confirmed TB (1.5% versus 1.1%, p=0.62) and new HIV (2.0% versus 1.8%, p=0.90) diagnoses were similar.
Conclusions Home-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation, likely due to challenges delivering the intervention components.
Abstract
In a household randomised trial in Kampala, Uganda, home-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation. Future studies will evaluate user-centred design to improve intervention delivery. http://bit.ly/2xwLpDu
Footnotes
This article has supplementary material available from openres.ersjournals.com
This study is registered with the Pan-African Clinical-Trials Registry under identifier number 201509000877140. Data available from the Dryad Digital Repository: https://doi.org/10.5061/dryad.kn4gv14.
Support statement: This study was supported by National Institutes of Health grant R01AI104824 (to J.L. Davis). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: J.L. Davis reports grants from National Institute of Allergy and Infectious Diseases, and the Fogarty International Center during the conduct of the study.
Conflict of interest: P. Turimumahoro has nothing to disclose.
Conflict of interest: A.J. Meyer has nothing to disclose.
Conflict of interest: I. Ayakaka has nothing to disclose.
Conflict of interest: E. Ochom has nothing to disclose.
Conflict of interest: J. Ggita has nothing to disclose.
Conflict of interest: D. Mark has nothing to disclose.
Conflict of interest: D. Babirye has nothing to disclose.
Conflict of interest: D.A. Okello has nothing to disclose.
Conflict of interest: F. Mugabe has nothing to disclose.
Conflict of interest: E. Fair has nothing to disclose.
Conflict of interest: E. Vittinghoff reports salary support for statistical analysis from the NIH during the conduct of the study.
Conflict of interest: M. Armstrong-Hough reports grants from National Institutes of Health during the conduct of the study.
Conflict of interest: D. Dowdy has nothing to disclose.
Conflict of interest: A. Cattamanchi has nothing to disclose.
Conflict of interest: J.E. Haberer reports grants from the NIH during the conduct of the study; and personal fees for consultation from Merck, and grants from USAID and the Gates Foundation, outside the submitted work.
Conflict of interest: A. Katamba has nothing to disclose.
- Received May 14, 2019.
- Accepted May 28, 2019.
- Copyright ©ERS 2019
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