TB REACH Wave 1 forest plot of the notification rate ratios for projects with control populations.

<p>TB REACH Wave 1 forest plot of the notification rate ratios for projects with control populations.</p

Comparative Meta-Analysis of Tuberculosis Contact Investigation Interventions in Eleven High Burden Countries

<div><p>Background</p><p>Screening of household contacts of tuberculosis (TB) patients is a recommended strategy to improve early case detection. While it has been widely implemented in low prevalence countries, the most optimal protocols for contact investigation in high prevalence, low resource settings is yet to be determined. This study evaluated contact investigation interventions in eleven lower and middle income countries and reviewed the association between context or program-related factors and the yield of cases among contacts.</p><p>Methods</p><p>We reviewed data from nineteen first wave TB REACH funded projects piloting innovations to improve case detection. These nineteen had fulfilled the eligibility criteria: contact investigation implementation and complete data reporting. We performed a cross-sectional analysis of the percentage yield and case notifications for each project. Implementation strategies were delineated and the association between independent variables and yield was analyzed by fitting a random effects logistic regression.</p><p>Findings</p><p>Overall, the nineteen interventions screened 139,052 household contacts, showing great heterogeneity in the percentage yield of microscopy confirmed cases (SS+), ranging from 0.1% to 6.2%). Compared to the most restrictive testing criteria (at least two weeks of cough) the aOR’s for lesser (any TB related symptom) and least (all contacts) restrictive testing criteria were 1.71 (95%CI 0.94−3.13) and 6.90 (95% CI 3.42−13.93) respectively. The aOR for inclusion of SS- and extra-pulmonary TB was 0.31 (95% CI 0.15−0.62) compared to restricting index cases to SS+ TB. Contact investigation contributed between <1% and 14% to all SS+ cases diagnosed in the intervention areas.</p><p>Conclusions</p><p>This study confirms that high numbers of active TB cases can be identified through contact investigation in a variety of contexts. However, design and program implementation factors appear to influence the yield of contact investigation and its concomitant contribution to TB case detection.</p></div

Project characteristics and description.

Project characteristics and description.</p

Association between program design or contextual factors and the percentage yield of contact tracing using random effect, exact binomial logistic regression.

<p>*The Odds ratio compares the chance of confirming contacts as being a SS+ case in different program designs and context settings</p><p>† Wald test of significance of effect; LLR test of significance of variable in the model</p><p>‡ variable could not be included in multivariate analysis due to unavailability of data for several projects</p><p>§ Coverage of contacts defined as percentage of identified contacts that enter screening algorithm</p><p>Association between program design or contextual factors and the percentage yield of contact tracing using random effect, exact binomial logistic regression.</p

Summary of TB REACH Wave 1 Case Finding Results – Quarterly Notification Rates.

†<p>Sputum Smear Positive abbreviated to SS+.</p

Yield of active case finding and proportion of notified SS+ cases found through contact investigation (n = 18).

<p>Yield of active case finding and proportion of notified SS+ cases found through contact investigation (n = 18).</p

Process Indicators in Contact Investigation.

<p>Process Indicators in Contact Investigation.</p

Number of people screened and number of smear positive (SM+) and all forms of TB identified through contact investigation in 19 projects.

<p>*Confidence intervals were derived through a Wilson score interval method</p><p>Number of people screened and number of smear positive (SM+) and all forms of TB identified through contact investigation in 19 projects.</p

Cost-effectiveness of TB REACH Wave 5 projects by project type.

Cost-effectiveness of TB REACH Wave 5 projects by project type.</p