Tuberculosis preventive treatment and care cascade among household contacts of patients starting tuberculosis treatment in Southern Africa: a multicountry cohort analysis
8 affiliations
- 1Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- 2Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- 3Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- 4Lighthouse, Lilongwe, Malawi
- 5SolidarMed, Masvingo, Zimbabwe
- 6SolidarMed, Chiure, Mozambique
- 7Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 8Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Abstract
Background: Tuberculosis preventive treatment (TPT) is recommended for household contacts of tuberculosis (TB) patients, yet implementation gaps persist, particularly in high-burden settings. We evaluated the TB preventive care cascade and determinants of TPT initiation among household contacts of patients with TB across five Southern African countries.
Methods: In a prospective cohort study within the International Epidemiology Database to Evaluate AIDS Southern Africa (IeDEA-SA), we enrolled all individuals aged ≥ 15 years with pulmonary TB starting treatment between October 2022 and March 2023 at five TB/HIV care clinics in Malawi, Mozambique, South Africa, Zambia and Zimbabwe. We analysed the preventive care cascade of their household contacts along sequential outcomes: healthcare visit, TB symptom reporting, microbiological testing, diagnosis and TPT initiation and completion. Determinants of TPT initiation were assessed using multivariable logistic regression.
Results: Among 1438 index patients with TB, 1369 (95%) reported at least one household contact, yielding 5805 contacts: 4529/5805 (78%) visited a healthcare facility and 877/4529 (19%) reported current TB symptoms, 297/4529 (7%) tested for TB, which was confirmed, latent or suspected in 74/4529 (2%). Among 4455 contacts visiting a healthcare facility with no confirmed, suspected or latent TB, only 223 (5%) initiated TPT, more frequently among people with HIV (OR 3.28, 95% CI 1.78 to 6.02) and children under 5 years (OR 3.27, 95% CI 1.42 to 7.54). At study end, 137 (61%) completed TPT, 84 (38%) were still on treatment, only 1 contact interrupted treatment and 1 had unknown status.
Conclusion: Despite high healthcare engagement among index patients, TPT initiation among household contacts in Southern Africa was low although relatively higher among priority groups such as people with HIV and young children. Strengthening the link between household contact screening and TPT uptake is essential to close the preventive care cascade gap in the region.
Related
- High Initiation but Suboptimal Completion of Tuberculosis-Preventive Treatment Among People Living With HIV on Antiretroviral Therapy, Persistent Tuberculosis Incidence, and Programmatic Implications: Findings From a 2-Year Multicountry Cohort Study
- Not Sick, Yet Treated: Barriers and Facilitators to Tuberculosis Preventive Treatment Uptake Among Household Contacts of Tuberculosis Patients in Moulvibazar District, Bangladesh
- Household contact management of drug-resistant tuberculosis: a global cost-effectiveness modelling analysis of expanded preventive treatment by age
- Health system and household costs of preventive treatment delivery for children exposed to multidrug-resistant tuberculosis in South Africa
- Determinants of willingness to accept Tuberculosis Preventive Treatment (TPT) among close contacts with Tuberculosis Infection (TBI) in Xinjiang, China
BibTeX
@article{wuthrich2026tuberculosis,
title = {{Tuberculosis preventive treatment and care cascade among household contacts of patients starting tuberculosis treatment in Southern Africa: a multicountry cohort analysis}},
author = {Leticia Wüthrich and Guy Muula and Denise Evans and Jacqueline Huwa and Cordelia Kunzekwenyika and Idiovino Rafael and Fiona Mureithi and Nelly Jinga and Amina Fernando and Agness Thawani and Marie Ballif and Lukas Fenner and Nicolas Banholzer and on behalf of IeDEA Southern Africa (IeDEA-SA)},
journal = {BMJ Global Health},
year = {2026},
month = oct,
doi = {10.1136/bmjgh-2026-025497},
url = {https://doi.org/10.1136/bmjgh-2026-025497},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Tuberculosis preventive treatment and care cascade among household contacts of patients starting tuberculosis treatment in Southern Africa: a multicountry cohort analysis
AU - Leticia Wüthrich
AU - Guy Muula
AU - Denise Evans
AU - Jacqueline Huwa
AU - Cordelia Kunzekwenyika
AU - Idiovino Rafael
AU - Fiona Mureithi
AU - Nelly Jinga
AU - Amina Fernando
AU - Agness Thawani
AU - Marie Ballif
AU - Lukas Fenner
AU - Nicolas Banholzer
AU - on behalf of IeDEA Southern Africa (IeDEA-SA)
PY - 2026
DA - 2026/10/30
JO - BMJ Global Health
DO - 10.1136/bmjgh-2026-025497
UR - https://doi.org/10.1136/bmjgh-2026-025497
AB - Background: Tuberculosis preventive treatment (TPT) is recommended for household contacts of tuberculosis (TB) patients, yet implementation gaps persist, particularly in high-burden settings. We evaluated the TB preventive care cascade and determinants of TPT initiation among household contacts of patients with TB across five Southern African countries. Methods: In a prospective cohort study within the International Epidemiology Database to Evaluate AIDS Southern Africa (IeDEA-SA), we enrolled all individuals aged ≥ 15 years with pulmonary TB starting treatment between October 2022 and March 2023 at five TB/HIV care clinics in Malawi, Mozambique, South Africa, Zambia and Zimbabwe. We analysed the preventive care cascade of their household contacts along sequential outcomes: healthcare visit, TB symptom reporting, microbiological testing, diagnosis and TPT initiation and completion. Determinants of TPT initiation were assessed using multivariable logistic regression. Results: Among 1438 index patients with TB, 1369 (95%) reported at least one household contact, yielding 5805 contacts: 4529/5805 (78%) visited a healthcare facility and 877/4529 (19%) reported current TB symptoms, 297/4529 (7%) tested for TB, which was confirmed, latent or suspected in 74/4529 (2%). Among 4455 contacts visiting a healthcare facility with no confirmed, suspected or latent TB, only 223 (5%) initiated TPT, more frequently among people with HIV (OR 3.28, 95% CI 1.78 to 6.02) and children under 5 years (OR 3.27, 95% CI 1.42 to 7.54). At study end, 137 (61%) completed TPT, 84 (38%) were still on treatment, only 1 contact interrupted treatment and 1 had unknown status. Conclusion: Despite high healthcare engagement among index patients, TPT initiation among household contacts in Southern Africa was low although relatively higher among priority groups such as people with HIV and young children. Strengthening the link between household contact screening and TPT uptake is essential to close the preventive care cascade gap in the region.
SN - 2059-7908
ER -