The ninth Technical Advisory Group and National TB Managers meeting Systematic TB screening: Operational research - Enhanced contact investigation of smear-positive tuberculosis patients in Mongolia J. Narantuya, Technical officer on HIV, AIDS, STIs, Tuberculosis and Hepatitis, WHO Mongolia The ninth Technical Advisory Group and National TB Managers meeting Manila, Philippines 9-12 December 2014

CONTENT Background Objectives Methods Implementation Preliminary results Policy implications and future directions Acknowledgement

BACKGROUND Prevalence of TB in 2013 (includes HIV+TB) 254 per 100,00 population (Global TB report, WHO 2014) Current practice is passive contact investigation Contact investigation form is not used

OBJECTIVES General objective To assess impact of enhanced contact investigation through introduction of active home-visit and new recording and reporting forms in Ulaanbaatar, Mongolia 2. Specific objectives To describe screening coverage of household TB contacts To determine prevalence of TB disease and latent TB infection among household contacts To determine secondary attack rate of pulmonary TB among household contacts To identify risk factors for TB disease and latent TB infection among household contacts To develop standard operating procedures (SOPs) for contact investigation

METHODS Study design Study area and population Cluster randomized control trial Study area and population 8 districts of Ulaanbaatar city (capital) have been selected randomly: 4 intervention and 4 control districts Target population: New smear positive pulmonary TB patients who are diagnosed and notified at district TB dispensary and their contacts 460 index cases and 1536 contacts were planned

METHODS Eligibility criteria Newly diagnosed smear-positive TB patients A household contact is defined as any person staying in the same household with index case for more than 3 months before the date of diagnosis of index cases Informed consent Excluding criteria: index patients who are less than 15 years of age; index patients who have a history of TB in the family index cases who have no household contact (living alone).

IMPLEMENTATION

IMPLEMENTATION Training of health providers Advocacy meetings with district health authorities Newly developed individual contact investigation form Questionnaires: For index case For household For contacts Diagnostic tools: Sputum smear microscopy Tuberculin skin test X-ray

PRELIMINARY RESULTS: Index cases and contacts Index (N=499) All smear-positive cases > 15 years in 8 districts Male 278 (55.7%) Housing House 157 (31.4%) Apartment 149 (29.8%) Ger 172 (34.4%) Contacts (N=1437) Average 3.8 per index Male 632 (44.0%)

Yield by (contact) age group Children Adults

Risk factors (determinants of yield) Risk factor analysis Index factors Household factors Individual factors Index factors (preliminary) Index aged 30-49 Unemployed Cough > 8 weeks X-ray cavity

POLICY IMPLICATIONS and FUTURE DIRECTIONS Include active contact investigation in the national guidelines Introduce new contact investigation form and use it by health providers Involve primary health providers and social workers Consider to implement active contact investigation Strengthen collaboration between: Primary health care providers (Family group practice) District TB dispensaries Local governors’ office

ACKNOWLEDGEMENT Dr Gantungalag, National TB Programme Dr Nobuyuki Nishikiori, STB, WPRO Dr Fukushi Morishita, STC TB surveillance and research department, NCCD District health departments in Ulaanbaatar TB doctors at the district TB dispensaries Primary health care providers (FGPs) in selected districts

THANK YOU!