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

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