How much is the contribution of contact investigation to

TB case finding?

Presented by:

Dr. Woojin Lew Medical Officer

STB/WHO-Philippines

Mantala, M1; Averilla, ML1; Carillo, AL1; Lew, W1;

Andaya, O2; Medina, A3, Vianzon, R4

1Stop TB, Office of the WHO Representative in the Philippines, Manila, Philippines; 2City Health Office-Taguig City, Metro Manila; 3Center for Health Development-Metro

Manila, Philippines; 4National TB Program, Department of Health, Philippines

Background • around 100,000 TB cases were undetected in the

Philippines in 2009

• WHO recommended contact investigation (CI) as one of the strategies to find the “missing” cases

• It is NTP’s policy to investigate contacts of notified TB cases

– implementation is erratic

– data are unavailable

• NTP, through the CATCH TB cases project, tested CI as one of the strategies to find additional TB cases

•

Collaboration for Additional TB cases through

Contacts and Hospitals against TB

Engaging

Hospitals

Focusing on

High Risk

Groups

Intensifying

Household

contact investigation

Diabetes Urban Poor

Objective • To determine the contribution of contact

investigation to the case finding outputs of the participating cities.

Coverage

• Six cities in Metro Manila, Philippines

• 2.4 million population

Key Activities • developed implementing

guidelines and tools

• trained the staffs of 87 health centers

• mobilized community volunteers to follow-up household contacts

• quarterly desk review by city

• regularly reviewed overall progress of the initiative

Procedure • Household members of registered

TB cases were evaluated by a health center physician and listed in a registry

• Screening, diagnosis and treatment followed the NTP policies

• TB patients identified were initiated treatment at the health center

• Data were consolidated and analyzed

Summary of Household Contact Investigation 87 health centers, July 2010 – June 2012

9,831 8,666

30,226

25,918

1,699 589 0

5000

10000

15000

20000

25000

30000

35000

Total Indexcase

identified

Index caseinvestigated

Totalcontacts

identified

Contactsscreened

TBsymptomatic

TB cases

88%

86%

7% 2%

4663 57 70

40

49 474412

33 50

78

0

50

100

150

200

250

Jul-Dec2010 Jan-Jun2011 Jul-Dec2011 Jan-Jun2012

<5 y/o 5-14 y/o 15 and up

Secondary TB Cases Found by Age Group,

per semester (n=589)

98

145 154

192 105 (18%) secondary TB

cases were smear positive

Contribution of CI to Case finding, Six cities, 2011 and First Semester, 2012

Cities

No. of

notified TB

cases,

2011

No. and

Percent

contributed by

CI

Muntinlupa 968 39 (4%)

Navotas 1,198 88 (7%)

Paranaque 667 29 (4%)

Pateros 119 10 (8%)

Pasay 562 35 (6%)

Taguig 1,063 96 (9%)

TOTAL 4,577 297 (6.5%)

Contribution of CI to Case Finding Six Cities, 2011

968

1,198

667

119

562

1,063

4% 7%

4% 8% 6%

9%

0

200

400

600

800

1000

1200

1400

Muntinlupa Navotas Paranaque Pateros Pasay Taguig

TB cases notified % Contribution

Contribution of CI to Case finding, Six cities, 2011 and First Semester, 2012

Cities

No. of

notified TB

cases,

2011

No. and

Percent

contributed by

CI

No. of

notified TB

cases, 1st

semester

2012

No. and

Percent

contributed

by CI

Muntinlupa 968 39 (4%) 517 27 (5%)

Navotas 1,198 88 (7%) 714 39 (5%)

Paranaque 667 29 (4%) 647 32 (5%)

Pateros 119 10 (8%) 71 9 (13%)

Pasay 562 35 (6%) 503 33 (7%)

Taguig 1,063 96 (9%) 1,186 52 (4%)

TOTAL 4,577 297 (6.5%) 3,638 192 (5.3%)

Operational problems and interventions

• Contacts not coming to health centers

• Used community volunteers to visit and convince them

• Decreasing TB symptomatics identified

• Decreasing yield of secondary TB cases detected

• Used CXR as screening in some areas

• Enhanced the symptomatology screening

• Use of a “guide” for community volunteers & health center staff to elicit signs and symptoms

• Perform DSSM for cough of ANY duration

Guide for health center staff and volunteers

Conclusion • Systematizing contact investigation

contributed in finding more TB cases especially among children.

• The NTP plans to incorporate the CI guidelines and tools in the revised Manual of Procedures.

• This strategy will be scaled up nationwide.

Thank You!