• 1.

    Houben RM, Dodd PJ, 2016. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS Med 13: e1002152.

    • Search Google Scholar
    • Export Citation
  • 2.

    World Health Organization, 2019. Global Tuberculosis Report, 2019. Available at: https://www.who.int/tb/publications/global_report/en/. Accessed March 5, 2020.

    • Search Google Scholar
    • Export Citation
  • 3.

    Pan American Health Organization, 2018. The End TB Strategy: Main Indicators in the Americas. Available at: https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=factsheets-5632&alias=44188-the-end-tb-strategy-main-indicators-americas-2018-188&Itemid=270&lang=en. Accessed January 10, 2020.

    • Search Google Scholar
    • Export Citation
  • 4.

    Fox GJ 2018. Household-contact investigation for detection of tuberculosis in Vietnam. N Engl J Med 378: 221229.

  • 5.

    Ayles H 2013. Effect of household and community interventions on the burden of tuberculosis in southern Africa: the ZAMSTAR community-randomised trial. Lancet 382: 11831194.

    • Search Google Scholar
    • Export Citation
  • 6.

    World Health Organization, 2012. Recommendations for Investigating Contacts of Persons with Infectious Tuberculosis in Low- and Middle-Income Countries. Geneva, Switzerland: WHO. Available at: https://www.who.int/tb/publications/2012/contact_investigation2012/en/. Accessed November 26, 2019.

    • Search Google Scholar
    • Export Citation
  • 7.

    Fox GJ, Dodd PJ, Marais BJ, 2019, Household contact investigation to improve tuberculosis control. Lancet Infect Dis 19: 235237.

  • 8.

    World Health Organization, 2018. Latent Tuberculosis Infection: Updated and Consolidated Guidelines for Programmatic Management. Geneva, Switzerland: WHO.

    • Search Google Scholar
    • Export Citation
  • 9.

    Pan American Health Organization, World Health Organization, 2016. Framework for Tuberculosis Control in Large Cities of Latin America and the Caribbean. Geneva, Switzerland: WHO. Available at: https://www.paho.org/en/documents/framework-tuberculosis-control-large-cities-latin-america-and-caribbean-2016. Accessed April 15, 2020.

    • Search Google Scholar
    • Export Citation
  • 10.

    Fox GJ, Barry SE, Britton WJ, Marks GB, 2013. Contact investigation for tuberculosis: a systematic review and meta-analysis. Eur Respir J 41: 140156.

    • Search Google Scholar
    • Export Citation
  • 11.

    Morrison J, Pai M, Hopewell PC, 2008. Tuberculosis and latent tuberculosis infection in close contacts of people with pulmonary tuberculosis in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis 8: 359368.

    • Search Google Scholar
    • Export Citation
  • 12.

    Armstrong-Hough M 2017. Drop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda: a prospective, multi-center study. PLoS One 12: e0187145.

    • Search Google Scholar
    • Export Citation
  • 13.

    Moore GF 2015. Process evaluation of complex interventions: medical research council guidance. BMJ 350: h1258.

  • 14.

    World Health Organization, Regional Office for the Eastern Mediterranean, 2017. HIV Test-Treat-Retain Cascade Analysis: Guide and Tools 2017, 2nd edition. Geneva, Switzerland: WHO. Available at: https://apps.who.int/iris/handle/10665/250533. Accessed October 12, 2019.

    • Search Google Scholar
    • Export Citation
  • 15.

    Subbaraman R, Nathavitharana RR, Satyanarayana S, Pai M, Thomas BE, Chadha VK, Rade K, Swaminathan S, Mayer KH, 2016. The tuberculosis cascade of care in India’s public sector: a systematic review and meta-analysis. PLoS Med 13: e1002149.

    • Search Google Scholar
    • Export Citation
  • 16.

    Subbaraman R, Nathavitharana RR, Mayer KH, Satyanarayana S, Chadha VK, Arinaminpathy N, Pai M, 2019. Constructing care cascades for active tuberculosis: a strategy for program monitoring and identifying gaps in quality of care. PLoS Med 16: e1002754.

    • Search Google Scholar
    • Export Citation
  • 17.

    Chin DP, Hanson CL, 2017. Finding the missing tuberculosis patients. J Infect Dis 216 (Suppl 7): S675S678.

  • 18.

    Hanson CL, Osberg M, Brown J, Durham G, Chin DP, 2017. Conducting patient-pathway analysis to inform programming of tuberculosis services: methods. J Infect Dis 216 (Suppl 7): S679s685.

    • Search Google Scholar
    • Export Citation
  • 19.

    Secretaría de Salud Pública Municipal de Cali, Alcaldia de Santiago de Cali, 2019. Informe de Vigilancia en Salud Pública de Tuberculosis (evento 813), semana epidemiológicas 1–52, AÑO, 2019. Cali, Colombia: Alcaldía de Santiago de Cali. (Document in Spanish).

    • Search Google Scholar
    • Export Citation
  • 20.

    Ministerio de Salud y Protección Social de Colombia. Instituto Nacional de Salud, 2018. Protocolo de vigililancia en Salud Publica. Bogotá, Colombia: INS. (Document in Spanish).

    • Search Google Scholar
    • Export Citation
  • 21.

    Ministerio de Protección Social de Colombia, Universidad Nacional de Colombia, 2007. Guia de promocion de salud y prevencion de enfermedades en la salud pública. Bogotá-Colombia: Scripto Ltda, Vol. 2 (Document in Spanish).

    • Search Google Scholar
    • Export Citation
  • 22.

    Departamento Administrativo de Planeación, Alcaldia de Santiago de Cali, 2016. Cali en Cifras. Cali, Colombia: Alcaldía de Santiago de Cali, 184 (Document in Spanish).

    • Search Google Scholar
    • Export Citation
  • 23.

    Observatorio de Seguridad, Secretaría de Seguridad y Justicia, Alcaldia de Santiago de Cali, 2019. Informe Homicidios por Comuna Enero 01 Dec 18 de 2019. Cali, Colombia: Alcaldía de Santiago de Cali.

    • Search Google Scholar
    • Export Citation
  • 24.

    Poveda AC, 2011. Economic development, inequality and poverty: an analysis of urban violence in Colombia. Oxford Development Stud 39: 453468.

    • Search Google Scholar
    • Export Citation
  • 25.

    Krystosik AR, Curtis A, Buritica P, Ajayakumar J, Squires R, Dávalos D, Pacheco R, Bhatta MP, James MA, 2017. Community context and sub-neighborhood scale detail to explain dengue, chikungunya and Zika patterns in Cali, Colombia. PLoS One 12: e0181208.

    • Search Google Scholar
    • Export Citation
  • 26.

    Krystosik AR, Curtis A, LaBeaud AD, Dávalos DM, Pacheco R, Buritica P, Álvarez Á, Bhatta MP, Rojas Palacios JH, James MA, 2018. Neighborhood violence impacts disease control and surveillance: case study of cali, Colombia from 2014 to 2016. Int J Environ Res Public Health 15: 2144.

    • Search Google Scholar
    • Export Citation
  • 27.

    Soares EC 2013. Tuberculosis control in a socially vulnerable area: a community intervention beyond DOT in a Brazilian favela. Int J Tuberc Lung Dis 17: 15811586.

    • Search Google Scholar
    • Export Citation
  • 28.

    Otero L, Battaglioli T, Ríos J, De la Torre Z, Trocones N, Ordoñez C, Seas C, Van der Stuyft P, 2020. Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data. Trop Med Int Health 25: 346356.

    • Search Google Scholar
    • Export Citation
  • 29.

    Courtwright A, Turner AN, 2010. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep 125 (Suppl 4): 3442.

  • 30.

    Yuen CM, Millones AK, Contreras CC, Lecca L, Becerra MC, Keshavjee S, 2019. Tuberculosis household accompaniment to improve the contact management cascade: a prospective cohort study. PLoS One 14: e0217104.

    • Search Google Scholar
    • Export Citation
  • 31.

    Biermann O, Lönnroth K, Caws M, Viney K, 2019. Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review. BMJ Open 9: e031284.

    • Search Google Scholar
    • Export Citation
  • 32.

    Gazetta CE, Ruffino-Netto A, Pinto Neto JM, Santos MeL, Cury MR, Vendramini SH, Villa TC, 2006. Investigation of tuberculosis contacts in the tuberculosis control program of a medium-sized municipality in the southeast of Brazil in 2002. J Bras Pneumol 32: 559565.

    • Search Google Scholar
    • Export Citation
  • 33.

    Otero L, Shah L, Verdonck K, Battaglioli T, Brewer T, Gotuzzo E, Seas C, Van der Stuyft P, 2016. A prospective longitudinal study of tuberculosis among household contacts of smear-positive tuberculosis cases in Lima, Peru. BMC Infect Dis 16: 259.

    • Search Google Scholar
    • Export Citation
  • 34.

    van’t Hoog AH, Langendam MW, Mitchell ZE, Cobelens FG, Sinclair D, Leeflang MMG, Lonnroth K, 2013. A Systematic Review of the Sensitivity and Specificity of Symptom- and Chest-Radiography Screening for Active Pulmonary Tuberculosis in HIV-Negative Persons and Persons with Unknown HIV Status .Geneva, Switzerland: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 35.

    World Health Organization, 2014. The End TB Strategy: Global Strategy and Targets for Tuberculosis Prevention, Care and Control after 2015 .Geneva, Switzerland: WHO. Available at: https://who.int/tb/strategy/End_TB_Strategy.pdf. Accessed December 12, 2019.

    • Search Google Scholar
    • Export Citation
  • 36.

    Ministerio de Salud y Protección Social de Colombia, 2016. Plan estratégico: “Hacia el Fin de la Tuberculosis”. Convenio 519 de 2015 Bogotá, Colombia: MSPS. (Document in Spanish).

    • Search Google Scholar
    • Export Citation
  • 37.

    Gomes VF, Andersen A, Wejse C, Oliveira I, Vieira FJ, Joaquim LC, Vieira CS, Aaby P, Gustafson P, 2011. Impact of tuberculosis exposure at home on mortality in children under 5 years of age in Guinea-Bissau. Thorax 66: 163167.

    • Search Google Scholar
    • Export Citation
  • 38.

    Perez-Velez CM, Marais BJ, 2012. Tuberculosis in children. N Engl J Med 367: 348361.

  • 39.

    World Health Organization, 2020. Contact Tracing in Context of COVID-19. Interim Guidence .Geneva, Switzerland: WHO. WHO/2019-nCoV/Contact_Tracing/2020.1. Available at: https://www.who.int/publications/i/item/contact-tracing-in-the-context-of-covid-19. Accessed August 15, 2020.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Evaluating the Quality of Tuberculosis Contact Investigation in Cali, Colombia: A Retrospective Cohort Study

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  • 1 Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia;
  • 2 Universidad Icesi, Cali, Colombia;
  • 3 Departamento de Salud Pública y Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia;
  • 4 Grupo de investigación en epidemiologia de servicios-Griepis, Facultad de Ciencias de la Salud, Universidad Libre Seccional Cali, Cali, Colombia;
  • 5 Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut;
  • 6 Secretaría de Salud Pública Municipal de Santiago de Cali-Programa de Control de Micobacterias, Cali, Colombia;
  • 7 Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut;
  • 8 Pulmonary, Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut

ABSTRACT

Tuberculosis (TB) contact investigation facilitates earlier TB diagnosis and initiation of preventive therapy, but little data exist about the quality of its implementation. We conducted a retrospective cohort study to evaluate processes of TB contact investigation for index TB patients diagnosed in Cali, Colombia, in 2017, including dropout at each stage and overall yield. We constructed multivariable models to identify predictors of completing 1) the baseline household visit and 2) a follow-up clinic visit for TB evaluation among referred contacts. Sixty-eight percent (759/1,120) of registered TB patients were eligible for contact investigation; 77% (582/759) received a household visit. Odds of completing a household visit were significantly lower among men (adjusted odds ratio [aOR]: 0.6; 95% CI: 0.4–0.9; P = 0.009) and patients living in Cali’s western zone (aOR: 0.5; 95% CI: 0.3–0.8; P = 0.008). Among 1880 screened contacts, 31% (n = 582) met the criteria for clinic referral, 47% (n = 271) completed a clinic visit, and 85% (231/271) completed testing. After adjusting for clustering by index patient, odds of completing referral were higher among contacts with cough (aOR: 22; 95% CI: 7.1–66; P < 0.001) and contacts living in the western zone (aOR: 4.1; 95% CI: 1.2–15; P = 0.03). The cumulative probability of a symptomatic contact from an eligible household completing TB evaluation was only 28%. The yield of active TB patients among contacts was only 0.3% (5/1880). Only 16% (17/103) of children aged < 5 years and none of the eight persons living with HIV, reported preventive therapy initiation. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.

Author Notes

Address correspondence to Beatriz E. Ferro, Departamento de Salud Pública y Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Postal code 760031, Cali, Colombia. E-mail: beferro@icesi.edu.co

Financial support: This study was funded by the Ministry of Science, Technology, and Innovation of Colombia-Minciencias (#211780763484CT834-2018). Funding was also provided by the National Institutes of Health Fogarty International Center (D43 TW010540), with the National Heart Lung and Blood Institute serving as a cosponsor.

Authors’ addresses: Gustavo Diaz, CIDEIM, Cali, Colombia, E-mail: gdiaz@cideim.org.co. Angela María Victoria and Beatriz E. Ferro, Universidad Icesi, Cali, Colombia, E-mails: angelamav7@hotmail.com and beferro@icesi.edu.co. Amanda J. Meyer and John Lucian Davis, Yale School of Public Health, New Haven, CT, E-mails: amanda.meyer@yale.edu and lucian.davis@yale.edu. Yessenia Niño and Lucy Luna, Secretaria de Salud Pública Municipal de Cali, Cali, Colombia, E-mails: yessenia.nino@cali.gov.co and lucy.luna@cali.gov.co.

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