title: Comparative meta-analysis of tuberculosis contact investigation interventions in eleven high burden countries.
abstract: BACKGROUND
  Screening of household contacts of tuberculosis (TB) patients is a recommended strategy to improve early case detection. While it has been widely implemented in low prevalence countries, the most optimal protocols for contact investigation in high prevalence, low resource settings is yet to be determined. This study evaluated contact investigation interventions in eleven lower and middle income countries and reviewed the association between context or program-related factors and the yield of cases among contacts.
  
  
  METHODS
  We reviewed data from nineteen first wave TB REACH funded projects piloting innovations to improve case detection. These nineteen had fulfilled the eligibility criteria: contact investigation implementation and complete data reporting. We performed a cross-sectional analysis of the percentage yield and case notifications for each project. Implementation strategies were delineated and the association between independent variables and yield was analyzed by fitting a random effects logistic regression.
  
  
  RESULTS
  Overall, the nineteen interventions screened 139,052 household contacts, showing great heterogeneity in the percentage yield of microscopy confirmed cases (SS+), ranging from 0.1% to 6.2%). Compared to the most restrictive testing criteria (at least two weeks of cough) the aOR's for lesser (any TB related symptom) and least (all contacts) restrictive testing criteria were 1.71 (95%CI 0.94-3.13) and 6.90 (95% CI 3.42-13.93) respectively. The aOR for inclusion of SS- and extra-pulmonary TB was 0.31 (95% CI 0.15-0.62) compared to restricting index cases to SS+ TB. Contact investigation contributed between <1% and 14% to all SS+ cases diagnosed in the intervention areas.
  
  
  CONCLUSIONS
  This study confirms that high numbers of active TB cases can be identified through contact investigation in a variety of contexts. However, design and program implementation factors appear to influence the yield of contact investigation and its concomitant contribution to TB case detection.
authors: Koninklijk Instituut voor de Tropen (KIT) Health, 1090HA Amsterdam, Netherlands.
authors: Lucie
authors: L
authors: Blok
authors: Stop TB Partnership, Geneva 1211, Switzerland.
authors: Suvanand
authors: S
authors: Sahu
authors: Stop TB Partnership, Geneva 1211, Switzerland.
authors: Jacob
authors: J
authors: Creswell
authors: Koninklijk Instituut voor de Tropen (KIT) Biomedical Research, 1105 AZ Amsterdam, Netherlands.
authors: Sandra
authors: S
authors: Alba
authors: Mott-MacDonald, London EC4M 7RB, United Kingdom.
authors: Robert
authors: R
authors: Stevens
authors: Koninklijk Instituut voor de Tropen (KIT) Biomedical Research, 1105 AZ Amsterdam, Netherlands.
authors: Mirjam I
authors: MI
authors: Bakker
mesh_terms: D000349:Africa; D001208:Asia; D016358:Contact Tracing; D003371:Cough / Q000209:etiology; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D015995:Prevalence; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*