Davis J Lucian, Turimumahoro Patricia, Meyer Amanda J, Ayakaka Irene, Ochom Emma, Ggita Joseph, Mark David, Babirye Diana, Okello Daniel Ayen, Mugabe Frank, Fair Elizabeth, Vittinghoff Eric, Armstrong-Hough Mari, Dowdy David, Cattamanchi Adithya, Haberer Jessica E, Katamba Achilles
Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Pulmonary, Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven CT, USA.
ERJ Open Res. 2019 Jul 29;5(3). doi: 10.1183/23120541.00112-2019. eCollection 2019 Jul.
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.
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.
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% 15%; difference -1%, 95% CI -9% to 7%, p=0.81) and yields of confirmed TB (1.5% 1.1%, p=0.62) and new HIV (2.0% 1.8%, p=0.90) diagnoses were similar.
Home-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation, likely due to challenges delivering the intervention components.
世界卫生组织（WHO）建议在低收入国家开展家庭结核病（TB）接触者调查，但大多数接触者并未完成全面的临床和实验室评估。
我们在乌干达坎帕拉进行了一项基于家庭、借助短信开展的家庭结核病接触者调查随机试验。社区卫生工作者（CHW）走访肺结核索引患者的家庭，以筛查家庭接触者是否感染结核病。整个家庭被随机分配至诊所（标准护理）或家庭（干预）评估组。在干预组中，CHW为成年人提供HIV检测；为有症状的接触者以及年龄≥5岁的HIV感染者（PLWH）采集痰液；并将痰液送检进行微生物检测。CHW将PLWH、5岁以下儿童以及任何无法完成痰液检测的人员转诊至诊所。痰液检测结果和/或随访指示通过自动短信发送。主要结局是在14天内完成全面的结核病评估；次要结局是筛查出的接触者中的结核病和HIV诊断及治疗情况。
190名索引患者的471名接触者被分配至干预组，182名索引患者的448名接触者被分配至标准护理组。CHW确定干预组中有190/471（40%）、标准护理组中有213/448（48%）的接触者需要进行结核病评估。在干预组中，CHW从91名符合痰液采集条件的接触者中的35名（39%）获取了痰液，并向190名接触者中的95名（50%）发送了短信。干预组和标准护理组在14天时完成结核病评估的情况（14%对15%；差异-1%，95%CI-9%至7%，p=0.81）以及确诊结核病的检出率（1.5%对1.1%，p=0.62）和新发HIV感染的检出率（2.0%对1.8%，p=0.90）相似。
基于家庭、借助短信的评估并未提高家庭结核病接触者调查的完成率或检出率，可能是由于实施干预措施存在困难。
