[20] PASSIVE VERSUS ACTIVE TUBERCULOSIS CASE FINDING AND ISONIAZID PREVENTIVE THERAPY AMONG HOUSEHOLD CONTACTS IN A RURAL DISTRICT OF MALAWI

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] PASSIVE VERSUS ACTIVE TUBERCULOSIS CASE FINDING AND ISONIAZID PREVENTIVE THERAPY AMONG HOUSEHOLD CONTACTS IN A RURAL DISTRICT OF MALAWI

[AUTHOR(S):] R Zachariah¹, MP Spielmann¹, AD Harries², P Gomani³, SM Graham^4-5, E Bakali³ and P Humblet⁶
¹Médecins Sans Frontières, Thyolo District, Malawi; ²National TB Control Program/DFID Technical advisor, Lilongwe, Malawi; ³Thyolo District Health Services, Ministry of Health and Population, Thyolo, Malawi; ⁴Malawi-Liverpool-Wellcome Clinical Research Programme, College of Medicine, Malawi; ⁵Liverpool School of Tropical Medecine, University of Liverpool, United Kingdom; and ⁶Médecins Sans Frontières, Medical Department, Brussels Operational Centre, Brussels, Belgium

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 20
Antiviral Therapy 2003; 8(Suppl. 1):S190

[ABSTRACT:] Setting: Thyolo District, rural Malawi.

Objectives: To compare passive to active case findings among household contacts of smear positive pulmonary tuberculosis(TB) patients for 1)TB case detection and 2) the proportion of child contacts under 6 years who are placed on isoniazid (INH) preventive therapy.

Design: Cross-sectional study Methods: Passive and active case findings were conducted among household contacts and the uptake of INH preventive therapy in children was assessed.

Results: There were 189 index TB cases and 985 household contacts. HIV prevalence among index cases was 69%. Prevalence of TB by passive case finding among 524 household contacts was 0.19% (191/100,000) which was significantly lower than with active finding among 461 contacts where it was 1.74% (1,735/100,000, P=0.01). Of 126 children in the passive cohort, 22 (17%) received INH while in the active cohort, 25 (22%) of 113 children received the drug. Transport costs associated with chest Xray (CXR) screening was the major reason for low INH uptake.

Conclusions: Where the majority of TB patients are HIV positive, active case finding among household contacts yields 9 times more TB cases and is an opportunity for reducing TB morbidity and mortality. The need for a CXR is an obstacle for the uptake of INH prophylaxis.

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