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Aranda Z, Vázquez S, Gopaluni A, Martínez L, Ramírez M, Jiménez A, Bernal D, Rodríguez AL, Chacón S, Vargas B, Fulcher IR, Barnhart DA. Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021. BMC Health Serv Res 2024; 24:97. [PMID: 38233915 PMCID: PMC10795220 DOI: 10.1186/s12913-024-10590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.
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Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México.
- Departamento de Salud, El Colegio de La Frontera Sur, San Cristóbal de Las Casas, Chiapas, México.
| | - Sandra Vázquez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Anuraag Gopaluni
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Mayra Ramírez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Ariwame Jiménez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Daniel Bernal
- Escuela de Gobierno y Transformación Pública, Instituto Tecnológico de Monterrey, Ciudad de Mexico, México
| | - Ana L Rodríguez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Selene Chacón
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Bruno Vargas
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard Data Science Initiative, Boston, MA, USA
| | - Dale A Barnhart
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health Rwanda (Inshuti Mu Buzima), Kigali, Rwanda
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ter Ellen F, Tielens K, Fenenga C, Mieras L, Schoenmakers A, Arif MA, Veldhuijzen N, Peters R, Ignotti E, Kasang C, Quao B, Steinmann P, Banstola NL, Oraga J, Budiawan T. Implementation approaches for leprosy prevention with single-dose rifampicin: A support tool for decision making. PLoS Negl Trop Dis 2022; 16:e0010792. [PMID: 36251696 PMCID: PMC9612816 DOI: 10.1371/journal.pntd.0010792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/27/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. Methodology The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool’s usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. Principal findings Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. Conclusion An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP. The chance of contacts of leprosy patients developing leprosy can be reduced by providing a single dose of rifampicin. The implementation of this type of post-exposure prophylaxis can be done in various ways. This study led to the development of the SDR-PEP decision support tool to select the most suitable approach. It was developed in two phases; first, a tool was drafted based on a literature review and expert interviews, this was followed by phase 2 in which interviews and a focus group discussion with intended users of the tool were held. Five SDR-PEP implementation approaches that have been developed so far were identified. Apart from the characteristics of these approaches, the tool lists five basic requirements for the successful implementation of any approach, and criteria that help to select the best approach in a given context. A flowchart supports the selection process. The study found that the tool can also be used for lobby and advocacy, to clarify SDR-PEP implementation and the choice for an approach, and in training on SDR-PEP implementation. Information about costs and cost-effectiveness of the approaches is limited. Further research will help to continue to improve the tool.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Benedict Quao
- National Leprosy Control Programme, Ghana Health Service, Accra, Ghana
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil Switzerland, University of Basel, Basel, Switzerland
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Vo LNQ, Forse RJ, Codlin AJ, Vu TN, Le GT, Do GC, Van Truong V, Dang HM, Nguyen LH, Nguyen HB, Nguyen NV, Levy J, Squire B, Lonnroth K, Caws M. A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam. BMC Public Health 2020; 20:934. [PMID: 32539700 PMCID: PMC7296629 DOI: 10.1186/s12889-020-09042-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale–up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies. Methods We conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications. Results We verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021). Conclusions Both salaried and volunteer CHW human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program. The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources.
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Affiliation(s)
- Luan Nguyen Quang Vo
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam. .,Interactive Research and Development, Ho Chi Minh City, Viet Nam.
| | - Rachel Jeanette Forse
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam
| | - Andrew James Codlin
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam
| | - Thanh Nguyen Vu
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
| | - Giang Truong Le
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
| | - Giang Chau Do
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | | | - Ha Minh Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | | | | | | | - Jens Levy
- KNCV Tuberculosefonds, The Hague, The Netherlands
| | - Bertie Squire
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | - Knut Lonnroth
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Maxine Caws
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK.,Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
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Kigozi NG, Heunis JC, Engelbrecht MC. Yield of systematic household contact investigation for tuberculosis in a high-burden metropolitan district of South Africa. BMC Public Health 2019; 19:867. [PMID: 31269950 PMCID: PMC6609408 DOI: 10.1186/s12889-019-7194-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 06/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background Systematic household contact investigation (SHCI) is recommended as an active-case-finding (ACF) strategy to identify individuals at high risk of tuberculosis (TB) infection, in order to enable early detection and treatment. Reluctance to implement SHCI in sub-Saharan African and South African high-burden contexts may stem from uncertainty about the potential yield of this strategy when targeting specific categories of TB index cases. In order to inform and motivate scale-up, this pilot study investigated the effectiveness of SHCI when targeting the World Health Organization’s (WHO) recommended categories of infectious index cases. Method Data were gathered in September and October 2016. Household contacts of infectious TB cases who attended 40 primary health care facilities in Mangaung Metropolitan District were recruited. The categories of TB index cases included 1) children <5 years, 2) HIV co-infected pulmonary TB (PTB) cases (≥5 years), 3) HIV-negative PTB cases (≥5 years), and 4) multidrug-resistant (MDR) TB cases. Contacts were screened for TB symptoms and symptomatic individuals and all children <5 years were referred for clinical evaluation. Data were analysed to establish the yield and factors associated with new TB diagnosis. Results Of 259 contacts screened, just under half (47.1%) underwent TB clinical investigation, during which 17 (6.6%) new TB cases were diagnosed, which represents a prevalence rate of 6564 per 100,000 population. Fifteen contacts needed to be screened to detect one new TB case. The proportion of new TB cases was the highest among contacts of HIV-negative PTB index cases (47.9%). The likelihood of TB diagnosis was higher among male contacts (odds ratio [OR]: 4.8; 95% confidence interval [CI]: 1.54–14.97) and those reporting coughing (OR: 4.3; 95% CI: 1.11–16.43). Conclusion The high yield of new TB observed in this pilot study demonstrates that targeted SHCI may be an effective ACF strategy in Mangaung and similar high-burden settings in South Africa. Targeting different index case categories produced variable yield – the highest among contacts of HIV-negative TB index cases. SHCI among household contacts of all four the WHO-recommended categories of infectious TB index cases – and male and coughing contacts, in particular – should be maximised.
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Affiliation(s)
- N Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
| | - J Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa
| | - Michelle C Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa
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Ohene SA, Bonsu F, Hanson-Nortey NN, Sackey A, Danso S, Afutu F, Klatser P, Bakker M. Yield of tuberculosis among household contacts of tuberculosis patients in Accra, Ghana. Infect Dis Poverty 2018; 7:14. [PMID: 29482625 PMCID: PMC5828410 DOI: 10.1186/s40249-018-0396-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background The End TB Strategy calls for systematic screening of selected high-risk groups including contacts of tuberculosis (TB) cases to facilitate early TB case detection. Contact investigation is not usually routinely practiced in low TB burden countries, such as Ghana, with consequent paucity of data on the yield of TB case detection from such interventions. This study’s objective was to document the outcomes and feasibility of implementing contact investigation activities under programmatic conditions in Ghana. Methods Retrospective analyses were conducted of abstracted data from the National TB Program, following a contact investigation intervention for TB cases diagnosed in 10 facilities in Accra from June 2010 to December 2014. Various proportions and yield from number of contacts needed to screen (NNS) and number needed to test (NNT) to detect a TB case were assessed. Results Overall, out of the 8519 listed contacts of 3267 index cases, 8166 (96%) were screened and 614 (7.5%) were identified as presumptive TB. Out of these, 438 (71%) underwent sputum smear microscopy/evaluation and 53 TB cases were diagnosed. Of these, 56.6% were males, and 49% had sputum smear-positive TB, 38% had sputum smear-negative TB, and 7% had extra-pulmonary TB. The NNS and NNT to detect a TB case of all forms were 154 and 8, respectively. The proportion of TB cases with contacts listed and proportion of contacts screened annually were 88–96% and 83–100%, respectively. The proportion of presumptive TB cases tested and proportion of TB cases diagnosed among contacts tested that were 100% and 36%, respectively, in 2010 dropped to 40% and 14%, respectively, by 2014. Conclusions The study demonstrates that contact identification and prioritization components of a contact investigation were feasible, but overall yield of TB cases may have been lower due to the declining rate of clinical evaluation of presumptive TB contacts over time. Addressing barriers to accessing appropriate diagnostic tests may enhance yield from contact investigation in Ghana. Electronic supplementary material The online version of this article (10.1186/s40249-018-0396-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office, 29 Volta Street Airport, Airport Residential Area, P.O. Box MB 142, Accra, Ghana.
| | - Frank Bonsu
- National Tuberculosis Control Program, Accra, Ghana
| | | | | | - Samuel Danso
- National Tuberculosis Control Program, Accra, Ghana
| | - Felix Afutu
- National Tuberculosis Control Program, Accra, Ghana
| | - Paul Klatser
- Department of Global Health, Academic Medical Centre, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
| | - Mirjam Bakker
- KIT Health, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
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