Assessing the effectiveness of contact tracing for multi drug resistant tuberculosis in Uganda

Abstract

Introduction: Multidrug-resistant tuberculosis (MDR-TB) poses a big threat in to the management of Tuberculosis (TB) disease in many countries including Uganda. MDR - TB can be transmitted from one person to another through prolonged exposure to a known case that has not been initiated or not responding to treatment. Globally in 2022, an estimated 410,000 people developed MDR/RR-TB and only 176,000 were started on treatment with a gap of 57% not initiated. Contact tracing activities have been implemented hence the need to assess the effectiveness of contact tracing among index cases to generate information and inform policy. Methods: This was a retrospective cohort study, all data of 224 MDR TB Index cases enrolled in care between January 2021 and December 2022 at the Mulago National Referral hospital Hospital (MNRH) MDR-TB treatment was extracted from DHIS 2 of the Ministry of health Health in excel Excel and contact tracing details were manually entered from the registers, exported to Stata Version 17 software and analyzed. Descriptive statistics were generated and multivariable analysis using poison regression to predict crude and adjusted prevalence ratios. Qualitative data was collected using 4 key informants’ interviews, that which were recorded, transcribed Verbatim, coded, and thematic analysis done was done using Atlas TI version 24 software. Results: Of the 224 index cases, 73% were male with a median age of 34.5years34.5 years with an interquartile range (IQR) of 26-44 years. Treatment outcomes for 78% of the index cases were recorded as culture negative culture-negative as an indication for of treatment success. Contact tracing coverage was 80% (180/224). A total of 905 contacts were identified and 251 tested and 26 confirmed positive with a yield of 10.4% (26/251). The factors associated with contact tracing were informal employment (aPR 0.59, 95% CI 0.45-0.77, p valuep-value <0.001) and the cured treatment outcome (aPR 1.13, 95% CI 1.00-1.27, p valuep-value <0.05). Health care worker attitude, support from the hospital administration, index case acceptability, housing, community involvement, and treatment adherence.