Household contact tracing with intensified tuberculosis and human immunodeficiency virus screening in South Africa: a cluster-randomized trial

Martinson, N. A. et al. (2022) Household contact tracing with intensified tuberculosis and human immunodeficiency virus screening in South Africa: a cluster-randomized trial. Clinical Infectious Diseases, 75(5), pp. 849-856. (doi: 10.1093/cid/ciab1047) (PMID:34950944) (PMCID:PMC9477445)

Abstract

Background Household contact tracing for tuberculosis (TB) may facilitate diagnosis and access to TB preventive treatment (TPT). We investigated whether household contact tracing and intensive TB/human immunodeficiency virus (HIV) screening would improve TB-free survival. Methods Household contacts of index TB patients in 2 South African provinces were randomized to home tracing and intensive HIV/TB screening or standard of care (SOC; clinic referral letters). The primary outcome was incident TB or death at 15 months. Secondary outcomes included tuberculin skin test (TST) positivity in children ≤14 years and undiagnosed HIV. Results From December 2016 through March 2019, 1032 index patients (4459 contacts) and 1030 (4129 contacts) were randomized to the intervention and SOC arms. Of intervention arm contacts, 3.2% (69 of 2166) had prevalent microbiologically confirmed TB. At 15 months, the cumulative incidence of TB or death did not differ between the intensive screening (93 of 3230, 2.9%) and SOC (80 of 2600, 3.1%) arms (hazard ratio, 0.90; 95% confidence interval [CI], .66–1.24). TST positivity was higher in the intensive screening arm (38 of 845, 4.5%) compared with the SOC arm (15 of 800, 1.9%; odds ratio, 2.25; 95% CI, 1.07–4.72). Undiagnosed HIV was similar between arms (41 of 3185, 1.3% vs 32 of 2543, 1.3%; odds ratio, 1.02; 95% CI, .64–1.64). Conclusions Household contact tracing with intensive screening and referral did not reduce incident TB or death. Providing referral letters to household contacts of index patients is an alternative strategy to home visits.

• Item Type: Articles
• Additional Information: This work was supported by the UK/South Africa Medical Research Council (MRC) Newton Fund (006Newton TB) and Wellcome (200901/Z/16/Z to P. M.). This research was funded in whole, or in part, by the Wellcome Trust [200901/z/16/Z].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Martinson, N. A., Lebina, L., Webb, E. L., Ratsela, A., Varavia, E., Kinghorn, A., Lala, S. G., Golub, J. E., Bosch, Z., Motsomi, K. P., and MacPherson, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Clinical Infectious Diseases
• Publisher: Oxford University Press
• ISSN: 1058-4838
• ISSN (Online): 1537-6591
• Published Online: 24 December 2021
• Copyright Holders: Copyright © The Author(s) 2021
• First Published: First published in Clinical Infectious Diseases 75(5):849–856
• Publisher Policy: Reproduced under a Creative Commons licence