Timeliness metrics for screening and preventing TB in household contacts of pulmonary TB patients in Kenya
D. Nair,
P. Thekkur,
I. Mbithi,
M. Khogali,
R. Zachariah,
S. Dar Berger,
S. Satyanarayana,
A. M. V. Kumar,
I. Kathure,
J. Mwangi,
A. F. Bochner,
A. McClelland,
J. M. Chakaya,
A. D. Harries
Affiliations
D. Nair
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;
P. Thekkur
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;
I. Mbithi
Respiratory Society of Kenya, Nairobi, Kenya;
M. Khogali
Institute of Public Health, College of Medicine and Health Sciences, University of the United Arab Emirates, Al Ain, United Arab Emirates;
R. Zachariah
United Nations Children Fund, United Nations Development Programme, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland;
S. Dar Berger
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;
S. Satyanarayana
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;
A. M. V. Kumar
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;
I. Kathure
Division of National TB, Leprosy and Lung Disease Programme, Ministry of Health, Nairobi,
J. Mwangi
Department of Health, Kiambu County Government, Kiambu, Kenya;
A. F. Bochner
Resolve to Save Lives, New York City, NY, USA;
A. McClelland
Resolve to Save Lives, New York City, NY, USA;
J. M. Chakaya
Respiratory Society of Kenya, Nairobi, Kenya;
A. D. Harries
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;
BACKGROUND: The study assessed whether a “7-1-7” timeliness metric for screening and TB preventive therapy (TPT) could be implemented for household contacts (HHCs) of index patients with bacteriologically confirmed pulmonary TB under routine programmatic settings in Kenya. METHODS: A longitudinal cohort study conducted among index patients and their HHCs in 12 health facilities, Kiambu County, Kenya. RESULTS: Between January and June 2023, 95% of 508 index patients had their HHCs line-listed within 7 days of initiating anti-TB treatment (“First 7”). In 68% of 1,115 HHCs, screening outcomes were ascertained within 1 day of line-listing (“Next 1”). In 65% of 1,105 HHCs eligible for further evaluation, anti-TB treatment, TPT or a decision for no drugs was made within 7 days of screening (“Second 7”). Altogether, 62% of screened HHCs started TPT during the “7-1-7” period compared with 58% in a historical cohort. Main barriers to TPT uptake were HHCs not consulting clinicians, HHCs being unwilling to initiate TPT and drug shortages. Healthcare workers felt that a timeliness metric was valuable for streamlining HHC management and proposed “3-5-7” as a workable alternative. CONCLUSIONS: The national TB programme must generate awareness about TPT, ensure uninterrupted drug supplies and assess whether the “3-5-7” metric can be operationalised.
