Evaluating the Quality of Tuberculosis Contact Investigation in Cali, Colombia: A Retrospective Cohort Study
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 were included, and none of the eight persons were living with HIV-initiated preventive therapy. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.
Author Notes
Financial support: This study was funded by the Administrative Department of Science, Technology, and Innovation of Colombia-Colciencias (#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 J. 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.