title: BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing.
abstract: BACKGROUND
  Limited data exists to inform contact tracing guidelines in children and HIV-affected populations. We evaluated the yield and additionality of household contact and source case investigations in Swaziland, a TB/HIV high-burden setting, while prioritizing identification of childhood TB.
  
  
  METHODS
  In partnership with 7 local TB clinics, we implemented standardized contact tracing of index cases (IC) receiving TB treatment. Prioritizing child contacts and HIV-affected households, screening officers screened contacts for TB symptoms and to identify risk factors associated with TB. We ascertained factors moderating the yield of contact tracing and measured the impact of our program by additional notifications.
  
  
  RESULTS
  From March 2013 to November 2015, 3,258 ICs (54% bacteriologically confirmed; 70% HIV-infected; 85% adults) were enrolled leading to evaluation of 12,175 contacts (median age 18 years, IQR 24-42; 45% children; 9% HIV-infected). Among contacts, 196 TB cases (56% bacteriologically confirmed) were diagnosed resulting in a program yield of 1.6% for all forms of TB. The number needed to screen (NNS) to identify a bacteriologically confirmed TB case or all forms TB case traced from a child IC <5 years was respectively 62% and 40% greater than the NNS for tracing from an adult IC. In year one, we demonstrated a 32% increase in detection of bacteriologically confirmed child TB. Contacts were more likely to have TB if <5 years (OR = 2.0), HIV-infected (OR = 4.9), reporting ≥1 TB symptoms (OR = 7.7), and sharing a bed (OR = 1.7) or home (OR = 1.4) with the IC. There was a 1.4 fold increased chance of detecting a TB case in households known to be HIV-affected.
  
  
  CONCLUSIONS
  Contact tracing prioritizing children is not only feasible in a TB/HIV high-burden setting but contributes to overall case detection. Our findings support WHO guidelines prioritizing contact tracing among children and HIV-infected populations while highlighting potential to integrate TB and HIV case finding.
authors.affiliation: The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, United States of America.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Mandalakas
authors.affiliation: The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, United States of America.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ngo
authors.affiliation: The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, United States of America.
authors.forename: Pilar
authors.initials: P
authors.lastname: Alonso Ustero
authors.affiliation: The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, United States of America.
authors.forename: Rachel
authors.initials: R
authors.lastname: Golin
authors.affiliation: Baylor College of Medicine Children's Foundation-Swaziland, Mbabane, Swaziland.
authors.forename: Florence
authors.initials: F
authors.lastname: Anabwani
authors.affiliation: The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, United States of America.|Baylor College of Medicine Children's Foundation-Swaziland, Mbabane, Swaziland.
authors.forename: Bulisile
authors.initials: B
authors.lastname: Mzileni
authors.affiliation: Swaziland National Tuberculosis Control Program, Mbabane, Swaziland.
authors.forename: Welile
authors.initials: W
authors.lastname: Sikhondze
authors.affiliation: Mott McDonald, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Stevens
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing / Q000379:methods*; D013541:Eswatini / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*