Household- Versus Incentive-Based Contact Investigation for Tuberculosis in Rural South Africa: A Cluster-Randomized Trial.
Household- Versus Incentive-Based Contact Investigation for Tuberculosis in Rural South Africa: A Cluster-Randomized Trial.
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南非农村地区结核病家庭与基于激励的接触者调查：整群随机试验。
DOI：
10.1093/cid/ciac920
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Dowdy,DavidW
中科院分区：
文献类型：
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作者：
Hanrahan,ColleenF;Nonyane,BarengAlettaSanny;Lebina,Limakatso;Mmolawa,Lesego;Siwelana,Tsundzukani;West,NoraS;Albaugh,Nicholas;Martinson,Neil;Dowdy,DavidW
背景：针对新诊断结核病患者的家庭接触调查实施得很差，特别是在低收入和中等收入国家。有条件的现金激励可能会提高接受度。方法我们在南非的28个公共初级保健诊所进行了一项实用的、集群随机的、交叉试验，研究了2种结核病接触者调查方法（基于家庭和基于激励）。每个诊所使用一种方法18个月，然后是6个月的洗脱期，之后使用相反的方法。每种方法随机选取14个诊所。在以家庭为基础的部门，我们对家庭接触者进行了结核病筛查和检测。在基于奖励的部分，指数患者及其≤10名密切接触者（家庭内外）到研究诊所进行结核病筛查，获得小额现金奖励。主要结果是在研究诊所诊断并开始治疗的偶发结核病患者的数量。结果从2016年7月至2020年1月，我们将28个诊所随机分配到每个研究组，在以家庭为基础的组中招募了782名指数结核病患者和1882名接触者，在以激励为基础的组中招募了780名指数结核病患者和1940名接触者。在以家庭为基础的治疗组中，共有1413人开始接受结核病治疗，在以奖励为基础的治疗组中，共有1510人开始接受治疗。在以激励为基础的治疗组与以家庭为基础的治疗组中，结核病开始治疗的调整发病率比为1.05（95%可信区间：0.97 - 1.13）。结论基于动机的结核病接触者调查与传统的以家庭为基础的方法具有相似的效果，可能是家庭为基础的调查的一种可行的替代或补充方法。
BackgroundHousehold contact investigation for people newly diagnosed with tuberculosis (TB) is poorly implemented, particularly in low- and middle-income countries. Conditional cash incentives may improve uptake.MethodsWe conducted a pragmatic, cluster-randomized, crossover trial of 2 TB contact investigation approaches (household-based and incentive-based) in 28 public primary care clinics in South Africa. Each clinic used 1 approach for 18 months, followed by a 6-month washout period, after which the opposite approach was used. Fourteen clinics were randomized to each approach. In the household-based arm, we conducted TB screening and testing of contacts at the household. In the incentive-based arm, both index patients and ≤10 of their close contacts (either within or outside the household) were given small cash incentives for presenting to study clinics for TB screening. The primary outcome was the number of people with incident TB who were diagnosed and started on treatment at study clinics.ResultsFrom July 2016 to January 2020, we randomized 28 clinics to each study arm, and enrolled 782 index TB patients and 1882 contacts in the household-based arm and 780 index patients and 1940 contacts in the incentive-based arm. A total of 1413 individuals started on TB treatment in the household-based arm and 1510 in the incentive-based arm. The adjusted incidence rate ratio of TB treatment initiation in the incentive- versus household-based arms was 1.05 (95% confidence interval: .97–1.13).ConclusionsIncentive-based contact investigation for TB has similar effectiveness to traditional household-based approaches and may be a viable alternative or complementary approach to household-based investigation.