title: A home tracing program for contacts of people with tuberculosis or HIV and patients lost to care.
abstract: METHODS
  Primary care clinic serving a high tuberculosis (TB) and human immunodeficiency virus (HIV) prevalence community in South Africa.
  
  
  OBJECTIVE
  To evaluate a program combining TB and HIV contact investigation with tracing of individuals lost to TB or HIV care.
  
  
  METHODS
  Contacts were offered home-based HIV testing, TB symptom screening, sputum collection and referral for isoniazid preventive therapy (IPT). Effectiveness was assessed by the number needed to trace (NNT).
  
  
  RESULTS
  Only 419/1197 (35.0%) households were successfully traced. Among 267 contacts, we diagnosed 27 new HIV cases (10 linked to care) and two TB cases (both initiated treatment) and three started IPT. Of 630 patients lost to care, 132 (21.0%) were successfully traced and 81 (61.4%) re-engaged in care. The NNT to locate one individual lost to care was 4.8 (95%CI 4.1-5.6), to re-engage one person in care 7.8 (95%CI 6.4-9.7), to diagnose one contact with HIV 44.3 (95%CI 30.6-67.0), to link one newly diagnosed contact to HIV care 120 (95%CI 65.3-249.2) and to find one contact with active TB and initiate treatment 599 (95%CI 166.0-4940.7).
  
  
  CONCLUSIONS
  The effectiveness of this contact tracing approach in identifying new TB and HIV cases was low. Methods to optimize contact investigation should be explored and their cost-effectiveness assessed.
authors.affiliation: Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: C B
authors.initials: CB
authors.lastname: Deery
authors.affiliation: University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Hanrahan
authors.affiliation: Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Selibas
authors.affiliation: Witkoppen Health and Welfare Center, Johannesburg, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Bassett
authors.affiliation: Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: I
authors.initials: I
authors.lastname: Sanne
authors.affiliation: University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
authors.forename: A
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D016358:Contact Tracing / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D055118:Medication Adherence; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation; D012111:Residence Characteristics; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid