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Targeting at-risk households: intensified case-finding for TB and HIV

Targeting at-risk households: intensified case-finding for TB and HIV in contacts of TB patients in South Africa. Adrienne E Shapiro , Modiehi H Rakgokong, Richard E Chaisson, Precious Modiba, Reginah Msandiwa, Jonathan E Golub, Ebrahim Variava, Neil A Martinson.

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Targeting at-risk households: intensified case-finding for TB and HIV

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  1. Targeting at-risk households: intensified case-finding for TB and HIV in contacts of TB patients in South Africa Adrienne E Shapiro, Modiehi H Rakgokong, Richard E Chaisson, Precious Modiba, Reginah Msandiwa, Jonathan E Golub, Ebrahim Variava, Neil A Martinson

  2. Active/Intensified Case-finding Intensified Case-Finding (ICF) Isoniazid Prophylaxis Infection Control • DOTS is passive case-finding • WHO 3 I’s • Multiple ICF approaches • Population • Screening algorithm • Meta-analysis of household contact screening 4.5% TB prevalence in HH contacts • Little data on HIV ICF Morrison J, Pai M, Hopewell PC. Lancet ID, 2008

  3. Background & Setting • South Africa HIV &TB: • Annual TB incidence: 948/100,000 • 5.7 million HIV+ • 94,000 TB deaths/yr in HIV+ • North West Province: - 200 TB admissions/month, 25% mortality • 4th highest provincial HIV prevalence • (18% among 15-24y)

  4. Study Area 10 km

  5. Methods • 800 index TB cases screened • 723 index TB + HH enrolled in 7 months • Study team (nurse + 2 lay counselors) home visit to evaluate household contacts • Single sputum specimen • AFB smear • TB culture (MGIT) • Drug susceptibility testing • VCT, CD4 • Referrals as indicated for rx or further evaluation • All rx in public sector, free

  6. Participant Demographics

  7. Results: TB 2,812 household contacts enrolled (723 HH) 2,146 (76%) gave sputum 666 did not (24%) give sputum 164 (8%) TB dx 1,982 (92%) TB neg 606 (91%) TB unk 60 (9%) on TB rx 95 (58%) Confirmed 69 (42%) Probable

  8. Results: HIV 2,812 contacts enrolled (723 HH) 1,610 (57%) VCT 997 (35%) Refused VCT 205 (7%) known HIV+ 1,446 (90%) HIV neg 164 (10%) HIV+ HIV unk 97 (59%) CD4>350 36 (22%)CD4 250-350 32 (19%) CD4<250 99 (48%) on ARVs

  9. TB: Index vs. Household Contact

  10. Contact tracing vs. random sampling

  11. Findings • Undetected TB (& HIV) highly prevalent in HH contacts of TB patients -TB in contacts less likely to be HIV+ -TB in contacts less likely to have TB symptoms • Sputum culture required to detect TB actively • Household case-finding for TB & HIV in the community is feasible - Welcomed by most households - Potential to adapt existing services in health district

  12. Acknowledgments • Participants • PHRU field teams • Matlosana Health Dept & Clinics, NWPG • National Health Laboratory Services, South Africa • Johns Hopkins University Center for TB Research; Johns Hopkins School of Medicine; Bloomberg School of Public Health • Funding: NIH/NIGMS; USAID via URC and ANOVA Health Institute The views expressed do not necessarily reflect those of USAID or the United States Government.

  13. Extra Slides

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