TPT for Household Contacts at Health Facility and Community Settings in Pakistan [TBN 083]

A study assessed whether adding community-based services to fixed health facilities improved completion of the tuberculosis preventive treatment (TPT) cascade among household contacts of individuals with TB. It was a programmatic cascade analysis within the Zero TB Initiative conducted from January 2018 to March 2021 in Karachi and Peshawar, Pakistan, using 8 health facilities in Karachi, 6 in Peshawar, and community-based mobile X-ray van services that began in May 2019.

Household contacts were first invited to fixed health facilities for evaluation. After 2 phone reminders and a household visit, contacts who did not attend but were reachable were offered community-based screening near the patient’s home. All contacts evaluated at facilities or mobile vans received symptom screening, clinical evaluation, chest radiography, and Xpert MTB/RIF testing using sputum or stool samples when indicated. Contacts in whom TB disease was ruled out were offered TPT regardless of TB infection status. Contacts aged 2 years or older received weekly isoniazid–rifapentine for 12 doses (3HP), while children younger than 2 years received 6 months of daily isoniazid (6H). Completion was defined as at least 11 of 12 3HP doses within 16 weeks or about 160 6H doses within 7 months, assessed using pharmacy records and self-report. The cascade included household contact enumeration, TB evaluation, TB diagnosis, TPT eligibility, TPT initiation, and TPT completion. The program did not capture the number prescribed TPT between eligibility and initiation. Level of evidence: observational programmatic implementation evidence.

Overall, 24,369 of 28,443 household contacts (85.7%) completed clinical evaluation; 20,855 (85.6%) were evaluated at health facilities and 3,514 (14.4%) in community settings. TB was diagnosed in 612 of 24,369 evaluated contacts (2.5%). Among 23,757 TPT-eligible contacts, 14,436 (60.8%) initiated TPT, and 10,879 of those initiating treatment (75.4%) completed it. Adding community-based services increased clinical evaluation by 12.4 percentage points (95% CI, 11.7 to 13.0), treatment completion by 11.6 percentage points (95% CI, 10.6 to 12.7), and overall cascade completion by 5.9 percentage points (95% CI, 5.1 to 6.7). In Karachi, community-based services increased cascade completion by 4.6 percentage points (95% CI, 3.7 to 5.4); in Peshawar, the increase was 10.6 percentage points (95% CI, 8.9 to 12.3).

In conclusion, adding community-based screening and TPT follow-up to fixed facility services improved evaluation, treatment completion, and overall TPT cascade completion among household contacts in two Pakistani cities. Key limitations include the observational programmatic design, reliance partly on self-reported treatment completion, absence of captured data on TPT prescription, and limited generalizability beyond urban Zero TB Initiative settings with mobile X-ray capacity.

Source: Jaswal MR, Martinez L, Brooks M, Farooq S, Safdar N, Shah JA, Islam Z, Nasir K, Fareed U, Manzar S, Maniar R. Tuberculosis-Preventive Treatment for Household Contacts at Health Facility and Community Settings in Pakistan. Clinical Infectious Diseases. 2025 Jun 15;80(6):1290-2.