Module 13: Contact Tracing/Examination

1. Module 13:Contact Tracing/Examination

2. Learning Objectives • Explain the purpose of contact tracing • Describe when to conduct contact tracing • Describe how to conduct a contact examination and which forms to use • List who should be included in a contact examination

3. Active Case Finding • Active case finding refers to health workers actively searching for patients in the community • Active case finding is one of the goals of TB/HIV collaborative activities to • Reduce the burden of TB among people living with HIV/AIDS • The most common method of active case finding in Botswana is contact tracing

4. Contact Tracing

5. What is Contact Tracing? Contact tracing is a procedure for: • Identifying persons exposed to someone with infectious TB disease • Evaluating those persons for active TB disease and latent TB infection (LTBI) • Providing appropriate treatment for those with active TB disease and LTBI

6. What is the Purpose of Contact Tracing? • Find persons who have active TB disease • so treatment can be given, • and further transmission stopped • Provide newborns and breast-feeding infants of smear-positive mothers with preventive therapy • Refer HIV-positive contacts for Isoniazid Preventive Therapy (IPT) screening

7. Key Terms • Index – The first case or patient who is reported to have TB disease • Source case or patient – The case or person who was original source of infection for secondary cases or contacts • can be, but is not necessarily, the index case

8. When to Conduct Contact Tracing? (1) • If a TB suspect is confirmed as smear-positive pulmonary TB case, an examination of all close contacts should be started • Contact tracing is not necessary for smear-negative pulmonary-TB or extrapulmonary TB -- unless index case is a child • FWEs usually conduct contact tracing

9. When to Conduct Contact Tracing? (2) • If the index case is a child, the source of the disease will be a person with pulmonary TB • Purpose of a source case investigation is to determine • who transmitted M. tuberculosis to child or index patient • if this person is still infectious • if the case of TB in this person was reported • if any others were infected by source patient

10. How to Conduct a Contact Tracing • Explain to TB patient that other people in the household may also be infected with TB • Explain the importance of treatment for household contacts • Ask patient to bring household contacts to health facility • Ask patient if they had close, regular, prolonged contact with others while infectious, especially in small, poorly ventilated places (i.e., mines, prison, etc…)

11. Conducting a Contact Tracing: Home Visits The initial patient home visit is an opportunity to • Initiate contact investigation • Determine if there are additional contacts – especially children • Recommend an HIV test

12. Contact Examination

13. Who Should be Included in a Contact Examination? • Household contacts • any person who lives in the home of a TB patient (sleeps and eats at least one meal per day there) • Other close contacts • anyone that patient spent close, regular, prolonged time with (i.e., coworkers or friends)

14. Steps for Conducting a Contact Examination (1) • Ask contacts to come to health facility to be examined or screen during home visits • Clinic staff prepare Contact Examination Forms • Initiate screening • Determine HIV status

15. Steps for Conducting a Contact Examination (2) • Should TB suspects be found, • enter names into the Suspect and Sputum Dispatch Register • Visiting medical officer brings suspected contacts for further evaluation to determine if “TB or Not TB”

16. Contacting Examination Forms (MH 1028)

17. Suspect and Sputum Dispatch Register

18. Detecting TB Cases among Adult Household Contacts (1) Adult household contacts (aged 15 years or more) • Fill out Contact Examination Form • Ask whether the individual has a cough and, if yes, for how long • If cough is 2 weeks or more, individual is a suspect for pulmonary TB • Enter into suspect register • Collect three sputum samples • Send sputum with Mycobacteriology Request Formto laboratory • Determine whether the TB suspect has smear-positive pulmonary TB

19. Detecting TB Cases among Adult Household Contacts (2) • If the sputum result is positive, the appropriate treatment should be started at once • If the sputum result is negative, refer patient to SDMO/MO for further investigation and for a final decision of "TB, or Not TB” • For HIV positive contacts • If sputum result positive, start appropriate TB treatment and refer for ARV treatment if not already started • If sputum result negative and TB disease ruled out, refer for IPT (and refer for ARV treatment if not already started) • If HIV status unknown offer routine HIV test

20. Detecting TB Cases among Child Contacts (1) For child contacts • Fill out Contact Examination Form • Check the child for TB symptoms, especially failure to thrive or grow, weight loss, cough and fever • Refer a child with any of these symptoms to a clinician for diagnosis or exclusion of TB • If the child has cough and can produce sputum, collect three samples for examination • Send sputum with Mycobacteriology Request Form to laboratory

21. Detecting TB Cases among Child Contacts (2) • Diagnosing TB in children (aged less than 15 years) can be difficult • Sputum difficult to obtain and usually negative • Clinician may make a diagnosis based on • clinical findings family history of contact with a sputum smear-positive case • x-ray • tuberculin test, culture (if available) • non-response to broad-spectrum antibiotic treatment

22. Staff Roles

23. Staff Roles • Clinic staff gather required information • Visiting Medical Officer brings suspected contacts for evaluation • Nurse and FWE interview and fill out the suspect and sputum dispatch register • The PHS/DMO/MO and nurse examine contacts

24. THERE IS NO SUCH THING AS NO CONTACTS!