title: Development and testing of models of tuberculosis contact tracing in rural southern Africa.
abstract: METHODS
  A regional hospital in rural Swaziland.
  
  
  OBJECTIVE
  To evaluate a hospital-based contact screening programme and test approaches to improve its effectiveness.
  
  
  METHODS
  An evaluation and quality improvement study of tuberculosis (TB) contact tracing services.
  
  
  RESULTS
  Hospital-based TB contact tracing led to screening of 157 (24%) of 658 contacts; of these, 4 (2.5%) were diagnosed with TB. Of 68 contacts eligible for human immunodeficiency virus (HIV) testing and counselling, 45 (66%) were tested and 7/45 (16%) were identified as HIV-positive. Twelve (50%) of 24 screened contacts aged <5 years were provided isoniazid prophylaxis. Three enhanced models of TB contact tracing were piloted to screen contacts in the community. Although some enhanced models screened large numbers of contacts, no contacts were diagnosed with TB.
  
  
  CONCLUSIONS
  Contact tracing of household members conducted in TB clinics within hospital settings is effective in high-burden, low-income settings, and can be provided using current resources. Enhanced household contact tracing models that followed up contacts in the community were not found to be effective. Additional resources would be required to provide household TB contact tracing in the community.
authors.affiliation: Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kliner
authors.affiliation: London Deanery, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Knight
authors.affiliation: Yorkshire and the Humber Deanery, University of Leeds, Leeds, UK.
authors.forename: J
authors.initials: J
authors.lastname: Elston
authors.affiliation: Good Shepherd Hospital, Siteki, Swaziland.
authors.forename: C
authors.initials: C
authors.lastname: Humphreys
authors.affiliation: Matsapha Health Care, Matsapha, Swaziland.
authors.forename: C
authors.initials: C
authors.lastname: Mamvura
authors.affiliation: Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wright
authors.affiliation: Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: J
authors.initials: J
authors.lastname: Walley
keywords: Swaziland; contact tracing; poverty; rural health; tuberculosis