Tuberculosis contact tracing and management

New tools to scale up tuberculosis contact tracing and management in a high-burden setting

Tuberculosis (TB) contact investigation is one of the main pillars of the World Health Organization’s End TB Strategy. This is a cost-effective way to find other cases of active TB and deliver preventive therapy to those most at risk of being infected and getting sick with TB (children aged <5 years and people with HIV). However, contact investigation and management is not done well in many resource-limited, high-burden settings.

Since 2017, we have been implementing a health system strengthening study at three clinics in Kota Kinabalu, Malaysia, to improve contact investigation and management. In this setting, many people live in poverty, the primary care system is poorly resourced, and TB rates are high. Our research has found that public health mechanisms are available for TB contact investigation, but only 56% of identified contacts had TB screening initiated. System inefficiencies need to be overcome to improve this.

A priority need is a tool to support prompt and accurate communication between the three agencies tasked with coordinating TB contact investigation, namely, health inspectors, healthcare staff and the District Health Office. Local consultation reveals that the best fix for this issue will be uptake of a data platform using freeware OpenMRS, to be used as a 3-way communication tool to identify and follow up TB contacts.

In this knowledge translation project, we will partner with service delivery and policy stakeholders to improve TB contact management in Kota Kinabalu, through:
– better data capture and sharing between health inspectors and clinics;
– simplification of TB screening to align with international practices
– strategies to improve the reach of contact investigation to community settings such as workplaces and schools

Anticipated outcomes include more active case finding and more TB prevention – both critically important in improving quality of life, reducing regional spread of TB and achieving End TB targets.

This project directly addresses aims articulated in the HOT NORTH Antimicrobial Resistance theme relating to drug resistant (DR)-TB in the region. It is also of high relevance to the Respiratory Health theme, with TB a leading cause of respiratory morbidity in the region. This project also addresses the HOT NORTH aims to: establish surveillance systems for TB in near neighbours; develop collaborative networks; and translate findings to regional treatment policies.

Actions that prevent people with latent TB from developing active TB – including DR-TB – are cost-effective. In Sabah, our genomic data show that DR-TB is largely acquired during treatment rather than being transmitted. By reducing case numbers of TB in the first place, the strategies our project is scaling up have potential for impact on regional DR-TB rates in the longer term.

DR-TB poses a grave threat to the WHO End TB Strategy targets of 90% reduction in case numbers by 2035 and elimination of TB as a public health problem by 2050. The danger posed to Australia’s tropical north by DR-TB is well recognized. We have published on extensively drug resistant TB at Queen Elizabeth Hospital, Sabah.

This translation project will work closely with service delivery teams and policy makers to bridge policy-practice gaps, streamline inefficient processes, generate outputs (educational tools and data capture and sharing systems) to support sustainability, and lead to important outcomes of TB prevention.