TABLE 2.
Outline of three enhanced models of TB contact tracing developed as part of quality improvement project and feedback after implementation
| Description of enhanced model | Feedback from implementation | Adaptations to models made |
| Model 1: phone call reminders (November 2011–February 2012) | ||
| Reminder by phone to attend at 1 month, and 7 days after if patient does not attend | Whole families were happy to be screened when seen at home, therefore screening in the community was mostly considered to be acceptable, although some stigma was present, with some families not wishing to engage. Contacts would often be at work or school | As patients are unlikely to attend the clinic after a reminder, contacts should be screened by phone. This will reduce the number of follow-up visits to be undertaken by motorcycle adherence officers |
| If patient does not attend, home visit from motorcycle adherence officer for TB screening | Feedback from contacts that travelling to hospital was too expensive | |
| Many contacts required home visits, which negatively impacted on other commitments of motorcycle adherence officers | ||
| Model 2: screening by phone (March–July 2012) | ||
| Screening of contact by phone at 7 days | Screening by phone yielded no positive screens. A number of households who reported no symptoms on the phone were visited and a number were found to be symptomatic | Screening by phone was removed from the model. A targeted model was introduced to ensure that only follow-up of high-risk contacts would be undertaken |
| If unable to contact, home visits from motorcycle adherence officers | Feedback from contacts was that they often did not know the symptoms of household contacts who may be at work or school and so denied symptoms on the phone | |
| Model 3: targeted screening (August–October 2012) | ||
| Home visit from motorcycle adherence officer for TB screening of high-risk patients* after 7 days | Considerable time taken by motorcycle adherence officer to visit communities. They can usually see two households per day, and contacts are often not in. This had impact on other, more urgent follow-up visits | |
| Second letter given to low-risk contacts at follow-up TB appointment | ||
*
Defined as an index case with multidrug-resistant TB, any member of the household aged <5 years and an index case with 3+ sputum smear.
TB = tuberculosis.