Tuberculosis Case Finding: Evaluation of a Paper Slip Method to Trace Contacts

SETTING: South Africa has the third highest tuberculosis (TB) burden in the world. Intensified case finding, recommended by WHO, is one way to control TB. OBJECTIVE: To evaluate the effectiveness and acceptability of a paper slip method for TB contact tracing. METHOD: TB patients were offered paper slips to give to their contacts, inviting them for TB screening. The number of contacts screened and the proportion diagnosed with TB was calculated. Contacts that returned to the clinic after receiving the slips were interviewed. A focus group discussion (FGD) with TB patients was held to determine their acceptability. RESULTS: From 718 paper slips issued, a 26% TB contact tracing rate was found, with a 12% case detection rate. The majority (68%) of contacts were screened within 2 weeks of receiving the slip. Age and gender were not significantly associated with time to screening. 16% of the contacts screened did not reside with the TB patients. 98% of the contacts said the method was acceptable. FGD findings show that this method is acceptable and may prevent stigma associated with TB/HIV. CONCLUSION: This simple, inexpensive method yields high contact tracing and case detection rates and potentially would yield additional benefits outside households.