title: Active contact investigation and treatment support: an integrated approach in rural and urban Sindh, Pakistan.
abstract: BACKGROUND
  Although household contacts of persons with tuberculosis (TB) have high rates of active TB, contact investigations are often not conducted. We present the results from a large-scale active contact investigation combined with treatment support in Sindh, Pakistan.
  
  
  METHODS
  Trained lay workers visited consenting smear-positive index patient homes in seven urban and 15 rural facilities. People with suspected TB were provided free transport to diagnostic centres, and sputum samples were collected for microscopy. Those diagnosed with smear-positive TB were given food baskets and sent text reminders to promote adherence.
  
  
  RESULTS
  From 3037 index cases, 19,191 household contacts were screened for TB symptoms and 3478 (18.1%) symptomatic persons were identified. Of these, 2160 (62.1%) produced sputum samples on the spot for testing and 490 (22.7%) had smear-positive results. TB prevalence in urban households was 1504 per 100,000 population compared to 4044/100,000 in rural households (P < 0.001) and 2553/100,000 overall. Treatment success was high, with 80.4% cured and 17.6% completing treatment.
  
  
  CONCLUSIONS
  Lay workers given basic training can conduct active contact investigations and provide treatment support to improve case detection and treatment outcomes in urban and rural areas of Pakistan. In areas with high levels of undiagnosed TB, particularly in rural areas, contact investigation should be prioritised as a means of improving case detection and early diagnosis.
authors.affiliation: Bridge Consultants Foundation, Karachi, Pakistan.
authors.forename: S A
authors.initials: SA
authors.lastname: Shah
authors.forename: S
authors.initials: S
authors.lastname: Qayyum
authors.forename: R
authors.initials: R
authors.lastname: Abro
authors.forename: S
authors.initials: S
authors.lastname: Baig
authors.forename: J
authors.initials: J
authors.lastname: Creswell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D005502:Food; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009752:Nutritional Status; D010154:Pakistan / Q000453:epidemiology; D011446:Prospective Studies; D017010:Reminder Systems; D019035:Rural Health Services / Q000458:organization & administration*; D013183:Sputum / Q000382:microbiology; D060145:Text Messaging; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D019037:Urban Health Services / Q000458:organization & administration*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents