Research led by The Union has found that it is feasible to incorporate contact investigation within national tuberculosis (TB) programmes in African countries.
Contact investigation is the identification and testing of people who have been in contact with someone with TB to assess whether they have active TB or are infected but do not yet have TB. The former is provided with appropriate anti-TB therapy and the latter is offered TB preventive treatment.
Dr Kobto Ghislain Koura, Director TB Department, said: “Despite the benefits of this intervention and being recommended for several years, it is not fully implemented and is poorly documented in low- and middle-income countries.”
The Union established the Contributing to the Elimination of Tuberculosis in Africa (CETA) project, with the initial objectives to implement contact investigation within national tuberculosis programmes (NTPs) and advocate for its scaling up at national level.
This latest project, published in Tropical Medicine and Infectious Disease journal, assessed the effectiveness of implementing contact investigation within the NTPs. The key findings from October 2020 to December 2021 include:
- 9,049 home visits were performed:
- 14,290 children under five years were identified and screened
- 287 people living with HIV were identified and screened
- The proportion of children under five years who were diagnosed with active TB were 2.6%
- The proportion of people living with HIV who were diagnosed with active TB were 10.1%
- 93% of children under five years and 98% of people living with HIV received TPT or TB treatment
The CETA project, funded by the Agence Française de Développement, is being delivered in collaboration with the NTPs of Benin, Burkina Faso, Cameroon, Central African Republican, Guinea, Niger, Senegal and Togo.
Contact investigation was implemented in 150 Basic Management Units identified across the eight countries. The target populations were children under five years and people living with HIV, who were evaluated during home and clinic visits.
Those who were in contact with someone who had active TB received TB treatment and those eligible received TB preventive therapy (TPT).
Dr Koura said: “The results show it is possible to incorporate contact investigation within African NTPs. I hope we can now work to integrate the intervention within more NTPs across the continent and beyond.”
In 2022, the scale-up for contact investigation partially or at national level was effective in six of the eight countries.
The lessons learned from the study are currently being used for the scale-up phase, which is being financed by the Global Fund and The Union.
Dr Koura added: “This scaling up of the intervention reflects the strong relationships between the NTPs, The Union, Global Fund, WHO and other international partners. Such good collaboration is vital to eliminate TB.”
From 2015 to 2019, The Union undertook an operational research study, the TITI project, in Benin, Burkina Faso, Cameroon and the Central African Republic. The project, funded by L’Initiative, demonstrated that contact investigation can be integrated within the NTPs with a few additional resources.
The TITI project findings led The Union, in collaboration with national tuberculosis programmes (NTPs) to include contact investigation in the first component of the CETA project.