Real-world multicountry programmatic assessment of contact investigation for people with drug-resistant tuberculosis: evidence from five high-burden countries
17 affiliations
- 1Innovation and Grants Team, Stop TB Partnership, Geneva, Switzerland
- 2FIT RD Social Enterprise Company Limited (FIT RD), Ha Noi, Viet Nam
- 3Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- 4Friends for International TB Relief, Ha Noi, Viet Nam
- 5Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- 6Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- 7Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- 8IRD Bangladesh, Dhaka, Bangladesh
- 9IRD Global, Republic Plaza, Singapore
- 10REACH Ethiopia, Addis Ababa, Ethiopia
- 11SUFABEL Community Development Initiative, State, Gombe, Nigeria
- 12PHTB Consult, Haren, The Netherlands
- 13Janna Health Foundation, Adamawa, Nigeria
- 14DOPASI Foundation, Islamabad, Pakistan
- 15New Dimension Consulting (T), Dar es Salaam, Tanzania, United Republic of
- 16KIT Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
- 17KIT Royal Tropical Institute, Amsterdam, The Netherlands
Abstract
Introduction: Contact investigation (CI) is a key strategy for ensuring tuberculosis (TB) diagnosis and prompt treatment initiation. However, its implementation remains limited, particularly for people with drug-resistant TB (DR-TB). This study summarises the approaches and presents yield cascades for DR-TB CI initiatives from five high-burden countries.
Methods: CIs were implemented via the Stop TB Partnership’s TB REACH Wave 9 funding cycle in Bangladesh, Ethiopia, Pakistan, Nigeria and Vietnam. Narrative data were thematically synthesised to identify shared and context-specific implementation strategies. Quantitative data included the number of index individuals with DR-TB, contacts screened and tested and TB diagnoses by drug resistance. Results were compared across countries.
Results: Three CI strategies were used: (1) symptom screening (Bangladesh, Ethiopia, Nigeria), (2) parallel symptom and chest X-ray screening (Pakistan) and (3) universal molecular testing (Vietnam). These were applied in diverse settings, including nomadic, displaced and urban populations. All sites conducted CI for people newly starting DR-TB treatment but CIs were also performed for historical cohorts of people with DR-TB in some contexts. A total of 3919 people with DR-TB were eligible for CI, and CI coverage was 95.2% (n=3732). A total of 11 184 household contacts were enumerated (average of 3.0 contacts per CI), and 10 901 (97.5%) were screened. 194 people were diagnosed with TB, of whom 165 (85.1%) were bacteriologically confirmed and 89 (53.9%) had rifampicin resistance. Drug-susceptible TB and DR-TB detection rates among DR-TB contacts were 1.5% (range 0.14–3.9%) and 0.8% (range 0–3.3%), respectively.
Conclusion: CI outcomes for DR-TB varied across settings. These findings support the scale-up of context-adapted CI to improve DR-TB detection and care. Scaling context-specific CI, linked with contact screening, diagnostic evaluation and preventive treatment, will be critical to disrupt DR-TB transmission and achieve End TB targets.
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BibTeX
@article{rahman2026realworld,
title = {{Real-world multicountry programmatic assessment of contact investigation for people with drug-resistant tuberculosis: evidence from five high-burden countries}},
author = {Md Toufiq Rahman and Han Thi Nguyen and Andrew James Codlin and Luan Nguyen Quang Vo and Lina Davies Forsman and Manzur Ul Alam and Shamsher Alam and Tapash Roy and Desalegn Zerihun Negia and Meseret Aseffa and Suraj Abdulkarim and Miranda Brouwer and Stephen John and Kinz ul Eman and Syed Karam Shah and Sode Matiku and Christina Mergenthaler and Jacob Creswell},
journal = {BMJ Global Health},
year = {2026},
month = oct,
doi = {10.1136/bmjgh-2025-021870},
url = {https://doi.org/10.1136/bmjgh-2025-021870},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Real-world multicountry programmatic assessment of contact investigation for people with drug-resistant tuberculosis: evidence from five high-burden countries
AU - Md Toufiq Rahman
AU - Han Thi Nguyen
AU - Andrew James Codlin
AU - Luan Nguyen Quang Vo
AU - Lina Davies Forsman
AU - Manzur Ul Alam
AU - Shamsher Alam
AU - Tapash Roy
AU - Desalegn Zerihun Negia
AU - Meseret Aseffa
AU - Suraj Abdulkarim
AU - Miranda Brouwer
AU - Stephen John
AU - Kinz ul Eman
AU - Syed Karam Shah
AU - Sode Matiku
AU - Christina Mergenthaler
AU - Jacob Creswell
PY - 2026
DA - 2026/10/28
JO - BMJ Global Health
DO - 10.1136/bmjgh-2025-021870
UR - https://doi.org/10.1136/bmjgh-2025-021870
AB - Introduction: Contact investigation (CI) is a key strategy for ensuring tuberculosis (TB) diagnosis and prompt treatment initiation. However, its implementation remains limited, particularly for people with drug-resistant TB (DR-TB). This study summarises the approaches and presents yield cascades for DR-TB CI initiatives from five high-burden countries. Methods: CIs were implemented via the Stop TB Partnership’s TB REACH Wave 9 funding cycle in Bangladesh, Ethiopia, Pakistan, Nigeria and Vietnam. Narrative data were thematically synthesised to identify shared and context-specific implementation strategies. Quantitative data included the number of index individuals with DR-TB, contacts screened and tested and TB diagnoses by drug resistance. Results were compared across countries. Results: Three CI strategies were used: (1) symptom screening (Bangladesh, Ethiopia, Nigeria), (2) parallel symptom and chest X-ray screening (Pakistan) and (3) universal molecular testing (Vietnam). These were applied in diverse settings, including nomadic, displaced and urban populations. All sites conducted CI for people newly starting DR-TB treatment but CIs were also performed for historical cohorts of people with DR-TB in some contexts. A total of 3919 people with DR-TB were eligible for CI, and CI coverage was 95.2% (n=3732). A total of 11 184 household contacts were enumerated (average of 3.0 contacts per CI), and 10 901 (97.5%) were screened. 194 people were diagnosed with TB, of whom 165 (85.1%) were bacteriologically confirmed and 89 (53.9%) had rifampicin resistance. Drug-susceptible TB and DR-TB detection rates among DR-TB contacts were 1.5% (range 0.14–3.9%) and 0.8% (range 0–3.3%), respectively. Conclusion: CI outcomes for DR-TB varied across settings. These findings support the scale-up of context-adapted CI to improve DR-TB detection and care. Scaling context-specific CI, linked with contact screening, diagnostic evaluation and preventive treatment, will be critical to disrupt DR-TB transmission and achieve End TB targets.
SN - 2059-7908
ER -