1. 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

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

3. 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

4. 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

5. 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

6. 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).

7. IMPLEMENTATION

8. 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

9. 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%)

10. Yield by (contact) age group
Children
Adults

11. 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

12. 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

13. 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

14. THANK YOU!