Data from: Home-based TB contact investigation in Uganda: a household-randomized trial

Introduction: The World Health Organization(WHO) recommends household
tuberculosis(TB) contact investigation in low-income countries, but most
contacts do not complete evaluation. Methods: We performed a randomized
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
adults HIV testing; collected sputum from symptomatic contacts and persons
living with HIV(PLWH) if ≥5 years; and transported sputum for
microbiologic testing. CHWs referred PLWH, children <5, and anyone
unable to complete sputum testing to clinic. Sputum-testing results and/or
follow-up instructions were returned by automated SMS. The primary outcome
was completion of TB evaluation within 14 days; secondary, 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%) sputum-eligible contacts and SMS were sent to
95/190(50%) contacts. Completion of TB evaluation in intervention and
standard-of-care arms at 14 days(14% vs 15%; difference -1%, 95%CI -9% to
+7%, p=0.81) and yields of confirmed TB(1.5% vs 1.1%, p=0.62) and new
HIV(2.0% vs. 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.