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2018 Jan 18 - Household-Contact Investigation for Detection of Tuberculosis in Vietnam

Greg J. Fox, M.B., B.S., Ph.D., Nguyen V. Nhung, M.D., Ph.D., Dinh N. Sy, M.D., Ph.D., Nghiem L.P. Hoa, M.P.H., Le T.N. Anh, B.P.H., Nguyen T. Anh, M.D., Ph.D., Nguyen B. Hoa, M.D., Ph.D., Nguyen H. Dung, M.D., Ph.D., Tran N. Buu, M.D., Ph.D., Nguyen T. Loi, M.P.H., Le T. Nhung, B.P.H., Nguyen V. Hung, B.P.H., Phan T. Lieu, B.P.H., Nguyen K. Cuong, M.D., Pham D. Cuong, B.A., Jessica Bestrashniy, Ph.D., Warwick J. Britton, M.B., B.S., Ph.D., and Guy B. Marks, M.B., B.S., Ph.D)

N Engl J Med 2018; 378:221-229

BACKGROUND

Active case finding is a top priority for the global control of tuberculosis, but robust evidence for its effectiveness in high-prevalence settings is lacking. We sought to evaluate the effectiveness of household-contact investigation, as compared with standard, passive measures alone, in Vietnam.

METHODS

We performed a cluster-randomized, controlled trial at clinics in 70 districts (local government areas with an average population of approximately 500,000 in urban areas and 100,000 in rural areas) in eight provinces of Vietnam. Health workers at each district clinic or hospital were assigned to perform either household-contact intervention plus standard passive case finding (intervention group) or passive case finding alone (control group). In the intervention districts, household contacts of patients with positive results for tuberculosis on sputum smear microscopy (smear-positive tuberculosis) were invited for clinical assessment and chest radiography at baseline and at 6, 12, and 24 months. The primary outcome was the cumulative incidence of registered cases of tuberculosis among household contacts of patients with tuberculosis during a 2-year period.

RESULTS

In 70 selected districts, we enrolled 25,707 household contacts of 10,964 patients who had smear-positive pulmonary tuberculosis. In the 36 districts that were included in the intervention group, 180 of 10,069 contacts were registered as having tuberculosis (1788 cases per 100,000 population), as compared with 110 of 15,638 contacts (703 per 100,000) in the control group (relative risk of the primary outcome in the intervention group, 2.5; 95% confidence interval [CI], 2.0 to 3.2; P<0.001); the relative risk of smear-positive disease among household contacts in the intervention group was 6.4 (95% CI, 4.5 to 9.0; P<0.001).

CONCLUSIONS

Household-contact investigation plus standard passive case finding was more effective than standard passive case finding alone for the detection of tuberculosis in a high-prevalence setting at 2 years. (Funded by the Australian National Health and Medical Research Council; ACT2 Australian New Zealand Clinical Trials Registry number, ACTRN12610000600044.)

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