THE VALUE OF DIFFERENT TUBERCULOSIS (TB) CASE DETECTION STRATEGIES IN CHILDHOOD TB CONTROL IN A HIGH-TB BURDEN POPULATION DENSE AREA, WESTERN KENYA, 2012-2015: A CLUSTER RANDOMIZED TRIAL

Year 2019, Volume: 4 Issue: 3, 200 - 213, 13.12.2019

Barbara Burmen Timothy Malika

https://doi.org/10.23884/ijhsrp.2019.4.3.05

Abstract

Contact investigation is recommended for close contacts of TB patients
to identify undiagnosed cases of active and latent TB to initiate them on
curative and preventive therapy respectively. Because contact invitation is
conducted in Kenya, the value of TB contact investigation in childhood TB
control is unknown. To compare the yield of contact investigation (intervention
arm) to contact invitation (control arm) in contributing to childhood TB
control, a cluster randomized trial was conducted in Kisumu County between 2014
and 2015 a period prior to the implementation of standardized contact
investigation. This was done to compare TB cases diagnosed and children
receiving IPT in the pre- intervention (2012-2013) and intervention (2014-2015) years, and in the intervention years using a minimum sample
size of 15 per arm. Of 77 facilities identified for the study, 65 facilities
were randomized to a contact screening strategy; a TB contact investigation
strategy in isolation (n=4), in combination with health facility screening
(n=19), or in combination with both enhanced facility screening and mobile
units (n=31) with the remainder, (n=11) randomized to the standard approach
i.e. TB contact invitation. Facilities distribution did not differ by category
of services or patient type. In the pre-intervention and post-intervention
years, TB number of TB cases diagnosed in children increased by 20 (75% from
intervention arm). During the intervention years TB cases decreased by 17 (29%
from intervention arm); the intervention arm contributed to 100% and 75% of the
children put on IPT whose implementation had just begun. Contact investigation
enhanced childhood TB control in comparison to routine approaches. Critical
support ought to be availed to the TB screening cascade to facilitate contact
investigation and IPT implementation as well as ingrain contact investigation
within existing community health systems.

Keywords

Tuberculosis control, Mobile screening, household contact investigation, enhanced facility detection, children

Supporting Institution

Kenya Medical Research Institution

Project Number

5U19GH000041

Thanks

We wish to thank the Kenya Medical Research Institute, Centers for Disease Control Kenya, Maseno University and the Division of Leprosy Tuberculosis and Lung Diseases in Kenya

References

• 1. Porter ME. What Is Value in Health Care? New England Journal of Medicine. 2010;363(26):2477-81. 2. Volpp KG, Loewenstein G, Asch DA. Assessing value in health care programs. JAMA. 2012;307(20):2153-4.
• 3. Dowdle WR. The principles of disease elimination and eradication. Bulletin of the World Health Organization. 1998;76 Suppl 2(Suppl 2):22-5.
• 4. Dye C, Hosseini M, Watt C. Did we reach the 2005 targets for tuberculosis control? Bull World Health Organ. 2007;85(5):364-9.
• 5. World Health Organization. Implementing the End TB Strategy: The essentials2016. Availablefrom: https://www.who.int/tb/publications/2015/The_Essentials_to_End_TB/en/.6. Murray CJL, Salomon JA. Expanding the WHO tuberculosis control strategy: rethinking the role of active case-finding [The Pittsfield Lecture]. Int J Tuberc Lung Dis. 1998;2(9):9-15.
• 7. Erkens CG, Kamphorst M, Abubakar I, Bothamley GH, Chemtob D, Haas W, et al. Tuberculosis contact investigation in low prevalence countries: a European consensus. Eur Respir J. 2010;36(4):925-
• 49. 8. MacIntyre CR, Plant AJ. Impact of policy and practice on the effectiveness of contact screening for tuberculosis. Prev Med. 1998;27(6):830-7.
• 9. Guwatudde D, Nakakeeto M, Jones-Lopez EC, Maganda A, Chiunda A, Mugerwa RD, et al. Tuberculosis in household contacts of infectious cases in Kampala, Uganda. Am J Epidemiol. 2003;158(9):887-98.
• 10. Sloot R, Schim van der Loeff MF, Kouw PM, Borgdorff MW. Risk of Tuberculosis after Recent Exposure. A 10-Year Follow-up Study of Contacts in Amsterdam. American Journal of Respiratory and Critical Care Medicine. 2014;190(9):1044-52.
• 11. Banu Rekha VV, Jagarajamma K, Wares F, Chandrasekaran V, Swaminathan S. Contact screening and chemoprophylaxis in India's Revised Tuberculosis Control Programme: a situational analysis. Int J Tuberc Lung Dis. 2009;13(12):1507-12.
• 12. Becerra MC, Pachao-Torreblanca IF, Bayona J, Celi R, Shin SS, Kim JY, et al. Expanding tuberculosis case detection by screening household contacts. Public Health Rep. 2005;120(3):271-7.
• 13. Ayles H, Muyoyeta M, Du Toit E, Schaap A, Floyd S, Simwinga M, et al. Effect of household and community interventions on the burden of tuberculosis in southern Africa: the ZAMSTAR community-randomised trial. Lancet. 2013;382(9899):1183-94.
• 14. Singh M, Mynak ML, Kumar L, Mathew JL, Jindal SK. Prevalence and risk factors for transmission of infetion among children in household contact with adults having pulmonary tuberculosis. Arch Dis Child. 2005;90:624-8.
• 15. World Health Organization. Recommendations for investigating contacts of persons with infectious Tuberculosis in low and middle income countries. 2012.
• 16. Division of Leprosy Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. 2013.
• 17. Chakhaia T, Magee MJ, Kempker RR, Gegia M, Goginashvili L, Nanava U, et al. High Utility of Contact Investigation for Latent and Active Tuberculosis Case Detection among the Contacts: A Retrospective Cohort Study in Tbilisi, Georgia, 2010–2011. PLOS ONE. 2014;9(11):e111773.
• 18. Kenya National Bureau of Statistics. 2009 Population and Housing Census2010. Available from: https://www.knbs.or.ke/publications/. 19. Fox GJ, Barry SE, Britton WJ, Marks GB. Contact investigation for tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2013;41(1):140-56.
• 20. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2011;9(8):672-7.
• 21. Bruce NG. Quantitative methods for health research : a practical interactive guide to epidemiology and statistics. Chichester: John Wiley; 2008.
• 22. Younge JO, Kouwenhoven-Pasmooij TA, Freak-Poli R, Roos-Hesselink JW, Hunink MGM. Randomized study designs for lifestyle interventions: a tutorial. International Journal of Epidemiology. 2015;44(6):2006-19.
• 23. Whitley E, Ball J. Statistics review 4: sample size calculations. Crit Care. 2002;6(4):335-41.24. Borgdorff MW. New measurable indicator for tuberculosis case detection. Emerg Infect Dis. 2004;10(9):1523-8.
• 25. Division of Leprosy Tuberculosis and Lung Disease. Annual Report 2012. 2013.26. National Tuberculosis Leprosy and Lung Disease Program. Kenya Tuberculosis Prevalence Survey 2016. 2017. Available from: https://www.chskenya.org/wp-content/uploads/2018/04/Final-TB-Prevalence-Survey-Report.pdf.
• 27. Speak A, Escobedo FJ, Russo A, Zerbe S. Comparing convenience and probability sampling for urban ecology applications. Journal of Applied Ecology. 2018;55(5):2332-42.
• 28. World Health Organization. Road Map for Childhood Tuberculosis. 2013.29. Sifuna P, Oyugi M, Ogutu B, Andagalu B, Otieno A, Owira V, et al. Health & demographic surveillance system profile: The Kombewa health and demographic surveillance system (Kombewa HDSS). Int J Epidemiol. 2014;43(4):1097-104.
• 30. Odhiambo FO, Laserson KF, Sewe M, Hamel MJ, Feikin DR, Adazu K, et al. Profile: the KEMRI/CDC Health and Demographic Surveillance System--Western Kenya. Int J Epidemiol. 2012;41(4):977-87.
• 31. County Government of Kisumu. Kisumu County: First County Integrated Development Plan 2013-20172013. Available from: file:///C:/Users/Burmen/Downloads/Kisumu%20County%20Integrated%20Development%20Plan.pdf.
• 32. Ministry of Health. Kenya Master Facility List2017. Available from: http://kmhfl.health.go.ke/.33. Issel LM. Health program planning and evaluation : a practical, systematic approach for community health. Sudbury, Mass. ; London: Jones and Bartlett Publishers; 2004.
• 34. Ministry of Public Health and Sanitation. National Paediatric Tuberculosis Care Guidelines. In: Division of of Leprosy TaLD, editor. Nairobi Kenya: Division of Leprosy, Tuberculosis and Lung Diseases; 2011. p. 55.
• 35. Azman AS, Golub JE, Dowdy DW. How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India. BMC Med. 2014;12:216.
• 36. Golub JE, Cohn S, Saraceni V, Cavalcante SC, Pacheco AG, Moulton LH, et al. Long-term protection from isoniazid preventive therapy for tuberculosis in HIV-infected patients in a medium-burden tuberculosis setting: the TB/HIV in Rio (THRio) study. Clin Infect Dis. 2015;60(4):639-45.
• 37. Festic E, Rawal B, Gajic O. How to improve assessment of balance in baseline characteristics of clinical trial participants-example from PROSEVA trial data? Annals of translational medicine. 2016;4(4):79-.
• 38. Parab S, Bhalerao S. Choosing statistical test. International journal of Ayurveda research. 2010;1(3):187-91.
• 39. Corbett EL, Bandason T, Duong T, Dauya E, Makamure B, Churchyard GJ, et al. Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial. Lancet. 2010;376(9748):1244-53.
• 40. Miller AC, Golub JE, Cavalcante SC, Durovni B, Moulton LH, Fonseca Z, et al. Controlled trial of active tuberculosis case finding in a Brazilian favela. Int J Tuberc Lung Dis. 2010;14(6):720-6.