Active Household Contact Screening for Tuberculosis and Provision of Isoniazid Preventive Therapy to Under-five Children in Afghanistan

Active Household Contact Screening for Tuberculosis and Provision of Isoniazid Preventive Therapy to Under-five Children in Afghanistan

By: Said Mirza Sayedi, Mohammad Khaled Seddiq, Mohammad K Rashidi, Ghulam Qader, Naser Ikram, Muluken Melese, Pedro G Suarez.  

Publication: PLoS One; 9 Oct. 2020; 15(10):e0240031. DOI: 10.1371/journal.pone.0240031

Abstract 

This observational study analyzed the performance of the National TB Control Program (NTP) in Afghanistan in household contact screening from 2011 to 2018 and its use as an entry point for isoniazid preventive therapy (IPT), as well as the IPT completion rates for children under age five. 

Results: From 2011 to 2018, 142,797 bacteriologically confirmed TB cases were diagnosed in Afghanistan. The number of household members eligible for screening was estimated to be 856,782, of whom 586,292 (81%) were screened for TB and 117,643 (20.1%) were found to be presumptive TB cases. Among the cases screened, 10,896 TB cases (all forms) were diagnosed (1.85%, 95% CI 1.82-1.89), 54.4% in females. The number needed to screen to diagnose a single case of TB (all forms) was 53.8; the number needed to test was 10.7. Out of all children under five, 101,084 (85.9%) were initiated on IPT, and 69,273 (68.5%) completed treatment. 

Conclusions: Program performance in contact screening in Afghanistan is high, at 81%, and the yield of TB is also high-close to 10 times higher than the national TB incidence rate. IPT initiation and completion rates are also high as compared to those of many other countries but need further improvement, especially for completion.