title: Integrated Source Case Investigation for Tuberculosis (TB) and HIV in the Caregivers and Household Contacts of Hospitalised Young Children Diagnosed with TB in South Africa: An Observational Study.
abstract: BACKGROUND
  Contact tracing, to identify source cases with untreated tuberculosis (TB), is rarely performed in high disease burden settings when the index case is a young child with TB. As TB is strongly associated with HIV infection in these settings, we used source case investigation to determine the prevalence of undiagnosed TB and HIV in the caregivers and household contacts of hospitalised young children diagnosed with TB in South Africa.
  
  
  METHODS
  Caregivers and household contacts of 576 young children (age ≤7 years) with TB diagnosed between May 2010 and August 2012 were screened for TB and HIV. The primary outcome was the detection of laboratory-confirmed, newly-diagnosed TB disease and/or HIV-infection in close contacts.
  
  
  RESULTS
  Of 576 caregivers, 301 (52·3%) self-reported HIV-positivity. Newly-diagnosed HIV infection was detected in 63 (22·9%) of the remaining 275 caregivers who self-reported an unknown or negative HIV status. Screening identified 133 (23·1%) caregivers eligible for immediate anti-retroviral therapy (ART). Newly-diagnosed TB disease was detected in 23 (4·0%) caregivers. In non-caregiver household contacts (n = 1341), the prevalence of newly-diagnosed HIV infection and TB disease was 10·0% and 3·2% respectively. On average, screening contacts of every nine children with TB resulted in the identification of one case of newly-diagnosed TB disease, three cases of newly diagnosed HIV-infection, and three HIV-infected persons eligible for ART.
  
  
  CONCLUSIONS
  In high burden countries, source case investigation yields high rates of previously undiagnosed HIV and TB infection in the close contacts of hospitalised young children diagnosed with TB. Furthermore, integrated screening identifies many individuals who are eligible for immediate ART. Similar studies, with costing analyses, should be undertaken in other high burden settings-integrated source case investigation for TB and HIV should be routinely undertaken if our findings are confirmed.
authors.affiliation: Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sanjay G
authors.initials: SG
authors.lastname: Lala
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Little
authors.affiliation: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Nkeko
authors.initials: N
authors.lastname: Tshabangu
authors.affiliation: Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: David P
authors.initials: DP
authors.lastname: Moore
authors.affiliation: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Reginah
authors.initials: R
authors.lastname: Msandiwa
authors.affiliation: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Martin
authors.initials: M
authors.lastname: van der Watt
authors.affiliation: Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chaisson
authors.affiliation: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence for Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martinson
mesh_terms: D017028:Caregivers; D002673:Child, Hospitalized; D002675:Child, Preschool; D016358:Contact Tracing; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission