Vikela Ekhaya: A Novel, Community-based, Tuberculosis Contact Management Program in a High Burden Setting.
HIV
contact tracing
global health
prevention and control
tuberculosis
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
03 05 2022
03 05 2022
Historique:
received:
10
05
2021
pubmed:
25
7
2021
medline:
10
5
2022
entrez:
24
7
2021
Statut:
ppublish
Résumé
The prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT. Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants' homes. In total, 945 contacts from 244 households were screened for TB symptoms; 72 (8%) contacts reported TB symptoms, and 5 contacts (0.5%) were diagnosed with prevalent TB. A total of 322 of 330 (98%) eligible asymptomatic household contacts initiated TPT. Of 322 contacts initiating TPT, 248 children initiated 3 months of isoniazid and rifampicin and 74 children and adults living with HIV initiated 6 months of isoniazid; 298 (93%) completed TPT. In clustered logistic regression analyses, unknown HIV status (adjusted odds ratio [aOR] 5.7, P = .023), positive HIV status (aOR 21.1, P = .001), urban setting (aOR 5.6, P = .006), and low income (aOR 5.9, P = .001) predicted loss from the cascade of care among TPT-eligible contacts. Vikela Ekhaya demonstrated that community-based TB household contact management is a feasible, acceptable, and successful strategy for TB screening and TPT delivery. The results of this study support the development of novel, differentiated, community-based interventions for TB prevention and control.
Sections du résumé
BACKGROUND
The prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT.
METHODS
Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants' homes.
RESULTS
In total, 945 contacts from 244 households were screened for TB symptoms; 72 (8%) contacts reported TB symptoms, and 5 contacts (0.5%) were diagnosed with prevalent TB. A total of 322 of 330 (98%) eligible asymptomatic household contacts initiated TPT. Of 322 contacts initiating TPT, 248 children initiated 3 months of isoniazid and rifampicin and 74 children and adults living with HIV initiated 6 months of isoniazid; 298 (93%) completed TPT. In clustered logistic regression analyses, unknown HIV status (adjusted odds ratio [aOR] 5.7, P = .023), positive HIV status (aOR 21.1, P = .001), urban setting (aOR 5.6, P = .006), and low income (aOR 5.9, P = .001) predicted loss from the cascade of care among TPT-eligible contacts.
CONCLUSION
Vikela Ekhaya demonstrated that community-based TB household contact management is a feasible, acceptable, and successful strategy for TB screening and TPT delivery. The results of this study support the development of novel, differentiated, community-based interventions for TB prevention and control.
Identifiants
pubmed: 34302733
pii: 6327779
doi: 10.1093/cid/ciab652
pmc: PMC9070808
doi:
Substances chimiques
Levonorgestrel
5W7SIA7YZW
Isoniazid
V83O1VOZ8L
Rifampin
VJT6J7R4TR
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1631-1638Subventions
Organisme : FIC NIH HHS
ID : K01 TW011482
Pays : United States
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
Références
Lancet Infect Dis. 2016 Nov;16(11):1269-1278
pubmed: 27522233
PLoS One. 2019 May 17;14(5):e0217104
pubmed: 31100097
PLoS One. 2017 Aug 1;12(8):e0182185
pubmed: 28763500
Clin Chest Med. 2009 Dec;30(4):827-46, x
pubmed: 19925970
Lancet Glob Health. 2018 Dec;6(12):e1329-e1338
pubmed: 30266570
PLoS One. 2017 Jan 20;12(1):e0169769
pubmed: 28107473
Lancet. 2020 Mar 21;395(10228):973-984
pubmed: 32199484
Pediatrics. 2018 Feb;141(2):
pubmed: 29363561
PLoS Med. 2019 Apr 30;16(4):e1002796
pubmed: 31039165
JAMA Pediatr. 2015 Mar;169(3):247-55
pubmed: 25580725
Int J Tuberc Lung Dis. 2018 Nov 1;22(11):1314-1321
pubmed: 30355411
Clin Infect Dis. 2020 Apr 15;70(9):1958-1965
pubmed: 31190072
N Engl J Med. 2018 Aug 2;379(5):454-463
pubmed: 30067928
Thorax. 2013 Mar;68(3):247-55
pubmed: 22717944
Clin Infect Dis. 2007 Sep 15;45(6):715-22
pubmed: 17712755
Pediatrics. 2006 Nov;118(5):e1350-9
pubmed: 17079536
Lancet. 2013 Oct 5;382(9899):1183-94
pubmed: 23915882
Int J Tuberc Lung Dis. 2006 Jan;10(1):13-8
pubmed: 16466031
Pediatrics. 2008 Jun;121(6):e1646-52
pubmed: 18519467
PLoS One. 2013 Dec 10;8(12):e80803
pubmed: 24339884
Clin Infect Dis. 2015 Jan 1;60(1):12-8
pubmed: 25270649