11.2 Procedure of contact Investigation

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The contact investigator should visit the home of the index patient to conduct interviews and ensure referral of all symptomatic household and close contacts for evaluation. In addition, all asymptomatic contacts will be evaluated for the eligibility of TPT as per NTP guidelines. Eligible contacts need to be counselled for proper referral by the Health care providers.

11.2.1 Who should be Included in a Contact Investigation?

All household and close contacts (ref, definitions above) of all bacteriological positive cases will be included. Contact investigation for less infectious cases (i.e. clinically diagnosed pulmonary TB) should also be carried out when possible.

The focus should be on household and close contacts, but people in the workplace and other settings in which there is exposure should not be ignored.

11.2.2 When to Conduct Contact Investigation?

  • If a Presumptive TB case is confirmed as a bacteriologically Positive Pulmonary TB case, an evaluation for all household and close contacts should be started
  • HCWs usually conduct contact tracing.
  • If contact investigation is to be initiated, the index case should be interviewed as soon as possible after diagnosis (generally within 1 week) to elicit the names of household and close contacts.

11.2.3 Who will be under investigation?

  • Household contacts: Any person who lives in the home of the TB patient (sleeps and eats at least one meal per day there)
  • Other close contacts: Any person who spends prolonged time closely with patient with TB regularly (i.e., coworkers or friends).

11.2.4 Steps of contact Investigation

  • For each Bacteriologically Confirmed patient a CI form will be initiated by the TLCA/ /responsible person for the DOT centres. One CI form will be generated for each Index case. For two or multiple patients in one family each form should be used for individual patient. DR TB contact Investigation form will be yellow, and the DS TB will be white colour.
  • TLCA/ DOT corner will fill in the upper portion of the CI form (Block A). TLCA will hand over all the CI form of the index cases to the HI/ HI (In-charge) to distribute this form to Govt field staff (HA, FWA, MPV)/NGO field staff. HI In-charge will hand over the CI forms to the relevant HAs during monthly/ weekly meeting and HAs will then conduct household visit to the index cases to collect further information of CI form (Block-B).
  • For urban settings, the respective field staff will fill in the upper portion of the CI form (Block A) and then distribute to the CHW (community Health care workers)/ DOT provider during the monthly/weekly staff meeting.
  • The responsible HA or the CHW (community Health care workers)/ DOT provider will visit the home of the Index Case for collecting further information and fill up Block-B of CI form of close contact of index case. S/he will interview the Index Case and family members to identify contacts. S/he will also do primary screening of symptoms of household and close contacts and refer all symptomatic (adult and children) to the respective Government Facilities/ NGO clinics for further evaluation.
  • All asymptomatic contacts of index DS TB cases should be referred for further evaluation and initiation of TPT to the respective Government Facilities / NGO clinics.
  • Only symptomatic contacts (all ages) of index DR TB cases should be referred for further evaluation to diagnose possible TB / DR TB.
  • HA/HCW will refer the contact by issuing a referral slip to each of those contacts.
  • After issuing a referral slip, HA will communicate with respective DOT Providers of index cases to ensure timely referrals.
  • The HA will return his/her filled in CI form to the HI during weekly/ monthly meeting and HI will hand over the form to the TLCA. The TLCA will fill up the CI registration book based on the information of CI form.
  • Returned CI form will be preserved at the treatment unit (upazilla Health Complex/ other government facilities/NGO clinics) where the contacts will be evaluated by a physician.
  • Referred contacts with the referral slips will be evaluated at the health facilities and the outcome of the evaluation will be documented in CI registration book.
  • Contact Investigation of hospitalised DR TB patients will be carried out by the concerned HA/ HCWs as soon as possible post admission. This will be done under the supervision of UH&FPO through TLCA.
  • Contact investigation Register should be maintained by the TLCA and the recorded data should be checked and countersigned by the UH&FPO monthly. Quarterly Contact Investigation report will be generated by the TLCA and sent to the NTP under the signature of UH&FPO.
  • Relevant NGO Workers and managers will ensure proper implementation of contact investigation and recording & reporting of CI.