CONTACT TRACING

MDR WORKSHOP : EThekwini District

Coastlands Hotel : Durban

18.09. 2015

Z.V Radebe – KZN TBCP

Outline

• Why contact tracing

• How

• Surveillance results

• Conclusion

MMWR – March 2005

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• The main purpose is to prevent the spread of

DRTB in the community.

Household surveillance of MDR/XDR

• 1st visit is conducted immediately after diagnosis of

index case

• Initially piloted in COSH and contacts were followed

twice over 2 years(Results available)

• Rolled out to the whole district in 2007 according to

WHO guidelines with the support of Italian

Cooperation.

METHOD

• After diagnosis of MDR/XDR case Household file with all contacts is opened by the tracer / injection team.

• Each index case household is mapped.

• Contacts are screened for the first time.

• Sputa for AFB and culture is taken from contacts.

• Suspected cases who cannot produce sputum with signs and symptoms are referred to hospital for X-ray.

• All contacts are offered VCT at a household level.

• Data for the household is documented ( health, social, etc.).

METHOD continued…

• Monteux test is done in children 5 yrs. and under.

• All children with positive Monteux , signs and symptoms of TB are sent for chest x-ray and VCT at hospital.

• The information is captured at the decentralized site.

• The list of households due for follow up at a specific Quarter is

sent out to sub-districts by the decentralized site as reminder.

• Sub districts follow up contacts and record findings on

household files every six months for 2 years

• Data is analyzed and report is compiled Quarterly/yearly.

What else is done during household

visit• Education on TB/HIV

• Education on IPC(Ventilation, cough hygiene, use of

mask etc.)

• What to do if there is anyone with signs and

symptoms of TB

• Referral to other departments e.g SASSA, Home

affairs

MDR Surveillance

2008 2009 2010

No HH visited 49 139 110

Contacts

Screened

296 895 609

Sputa collected 148 257 94

Monteux Test

done

26 44 15

AFB Positive 2 1 2

Culture Positive 2 2 2

MDR Diagnosed 1 0 0

XDR Diagnosed 0 0 0

Results of contact tracing from Q1/09 to Q3/09.

1st visit 2nd visit 3rd visit 4th visit

Contacts

screened

1846 1334 930 127

TB 9 = 0.5% 8 =0.6% 0 0

MDR 12 = 0.7% 0 0 0

XDR 16 = 0.9% 1= 0.07% 0 0

Total Pos 37 = 2% 9(0.67) =1% 0 0

Conclusion• Early tracing of household contacts is essential and

leads to:

• Decrease in transmission of MDR

• Decrease in death rate (MDR survival rate)

• Community awareness on importance of IPC in the

household(one to one education is given on IPC –

KAP study)

• Study conducted by MRC- KZN shows decrease in

XDR incidence at UMzinyathi but other districts

show increase!

Change in incidence of XDR-TB in KwaZulu-Natal

province, South Africa, 2007 to 2010–

122007(MRC)

Change in incidence of XDR-TB in KwaZulu-Natal

province, South Africa, 2007 to 2010–12

The end

• Siyabonga

•Thank you