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 diagno...