TB disease yield from household contact screening of TB index patients in Pakistan.

The national guidelines recommend contact screening of a subset of patients with the TB index and their household contacts (HHCs). Thus, many contacts with TB remain unscreened.We collected prospective data under programmatic conditions in Karachi, Pakistan, from January 2018 to December 2019. We screened all HHCs of all patients using the TB index. We disaggregated the data into guideline-eligible or ineligible index patients and contacts. We calculated TB disease yields for different groups of index patients and contacts.Of 39,168 HHCs from 6,450 index patients, 21,035 completed clinical assessments for TB, and 416 were diagnosed with all forms of TB. HHCs of patients with clinically diagnosed pulmonary TB (PTB) were as likely to be diagnosed with TB as the HHCs of patients with bacteriologically confirmed PTB (adjusted OR 1.28, 95% CI 0.94-1.75). The yield of TB disease among child contacts (3.4%) was significantly higher than that among adult contacts (0.5%) (P < 0.001).Broadening household contact screening criteria could increase the yield of contact tracing and improve the diagnosis of TB. However, further studies are required to establish the feasibility and cost-effectiveness of this approach, including studies from more diverse settings..

Implementing 3HP vs. IPT as TB preventive treatment in Pakistan.

BACKGROUND: We assessed treatment uptake and completion for 6 months of isoniazid (6H) and 3 months of isoniazid plus rifapentine weekly (3HP) in a programmatic setting in Pakistan.METHODS: All household contacts were clinically evaluated to rule out TB disease. 6H was used for TB preventive treatment (TPT) from October 2016 to April 2017; from May to September 2017, 3HP was used for contacts aged ≥2 years. We compared clinical evaluation, TPT uptake and completion rates between contacts aged ≥2 years in the 6H period and in the 3HP period.RESULTS: We identified 3,442 contacts for the 6H regimen. After clinical evaluation, 744/1,036 (72%) started treatment, while 46% completed treatment. In contrast, 3,722 contacts were identified for 3HP. After clinical evaluation, 990/1,366 (72%) started treatment, while 67% completed treatment. Uptake of TPT did not differ significantly between the 6H and 3HP groups (OR 1.03, 95%CI 0.86-1.24). However, people who initiated 3HP had 2.3 times greater odds (95% CI 1.9-2.8) of completing treatment than those who initiated 6H after adjusting for age and sex.CONCLUSION: In programmatic settings in a high-burden country, household contacts of all ages were more likely to complete TPT with shorter weekly regimens, although treatment uptake rate for the two regimens was similar.

Improving childhood tuberculosis detection and treatment through facility-based screening in rural Pakistan.

SETTING: Many children with tuberculosis (TB) remain undiagnosed due to the absence of services, lack of child-friendly diagnostics and underappreciation of TB as a common cause of childhood illness. OBJECTIVE: To show the impact of systematic verbal screening and contact tracing with appropriate management services on TB case finding in pediatric populations. DESIGN: Between October 2014 and March 2016, children were verbally screened at the pediatric out-patient departments of four public hospitals in Jamshoro District, Pakistan. Children with symptoms or risk of TB were referred for clinical evaluation and free chest X-ray and bacteriological tests. Children with TB were started on treatment and their care givers asked to bring household members to the hospital for screening. RESULTS: Over 105 000 children were verbally screened and 5880 presumptive childhood TB patients were identified; 1417 children (prevalence 1.3%) were diagnosed with TB; 43% were female. The median age was 5 years; 82% had pulmonary TB. An additional 390 children with TB were diagnosed through contact tracing. These activities resulted in a three-fold increase in pediatric TB case notifications. CONCLUSION: Systematic verbal screening with clinical evaluation and free diagnostics can identify children with TB who may otherwise be missed in rural health settings.