STS: Contact Investigation

Contact tracing is a process to identify people who are  at a high risk of developing TB due to their contact with a known TB case.

The aim of contact tracing is to find other people with TB disease and those infected with TB

All close contacts, especially household contacts of a Pulmonary TB patient, should be screened for TB. 

In paediatric TB patients, reverse contact tracing for the search of any active TB case in the child's household must be undertaken.

Particular attention should be paid to contacts with the highest susceptibility to TB infection.

Figure: Contacts to be Prioritized for contact TB screening

 

Index TB patient: Initially identified person of any age with new or recurrent TB in a specific household or other comparable settings in which others may have been exposed. The Index TB patient is the person on whom a contact investigation is centred, but is not necessarily the source/ primary case.

Contact: Any individual who was exposed to a person with active TB disease

Household Contact (HHC): Person who shared the same enclosed living space as the index TB patient for one or more nights or for frequent or extended daytime periods during the three months before the start of current TB treatment.

Close contact: Person who is not in the household but shared an enclosed space, such as at a social gathering, workplace or facility, for extended periods during the day with the index TB patient during the three months before the commencement of the current TB treatment episode. 

Contact tracing: Contact tracing is the process of listing out all the contacts (household contacts and close contacts) of the index TB patient. Contact tracing has to be done for all Index TB cases, whether pulmonary (sputum positive or negative) or Extra-pulmonary (EPTB). As per the current policy, it is compulsory to trace household contacts but it is desirable to trace other close contacts (workplace, social gathering etc) also. 

Why Contact Tracing  is done: Contact tracing is followed by contact investigation to identify active TB cases and Tuberculosis Preventive Treatment (TPT) beneficiaries.

Contact investigation: This is a systematic process for identifying previously undiagnosed people with TB disease and TB infection, among the contacts of an index TB patient.

Conducting Contact Tracing and Contact Investigation

Once a new/ recurrent TB case is diagnosed (ideally within 1 week), a healthcare worker (usually the Multipurpose Worker (MPW) from the nearby public health facility visits/ tele calls the patient’s household, interviews the patient about his/her contacts in the household and other settings such as workplace or social gatherings. The contacts’ details are recorded in a standardised format and entered in Ni-kshay contact tracing module. Each contact's details enter the workflow as a presumptive TB case or TPT beneficiary.

The traced contacts are screened for TB using a symptom checklist and if found to have any symptoms suggestive of TB, they are tested using X-ray/ sputum microscopy/ Cartridge-based Nucleic Acid Amplification Test (CBNAAT) as required. 

 

Outcome of Contact Tracing and Contact Investigation

• Those contacts diagnosed with active TB are initiated TB treatment.
• As per the current policy, those HHC of sputum-positive Pulmonary TB (PTB), in whom active TB disease is ruled out, are considered for TB Preventive Therapy (TPT)

 

References

• Guidelines for Programmatic Management of TB Preventive Treatment in India, 2021.
• Technical and Operational Guidelines for Tuberculosis Control in India, 2016.

 

Assessment

 

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Which of the following statements are true?	Contact tracing should always be followed by contact investigation.	Household contacts of Extrapulmonary TB are offered TPT.	The index case is always the primary source of infection in the household.	Contact tracing and investigation need to be done only during ACF campaigns.	1	2- Only HHC of Sputum positive PTB cases are offered TPT. 3 – The index case need not be the primary source of infection in the household. 4 – Contact tracing and investigation are to be done routinely for all TB cases. ACF campaigns are only an added measure.	​	Yes	Yes

Contact Tracing plays an important role in the detection of all those who are secondarily infected for proper diagnosis and prompt treatment. This process can be recorded and reported in Ni-kshay under the ‘contact tracing’ option. The process of recording contact tracing in Ni-kshay is given below.

 

Process Overview

Detailed Step-wise Procedure

 

Step 1: Login to the Ni-kshay ecosystem and enter the patient ID for which the contact tracing details are being recorded.

Step 2: Click on the ‘Contact tracing’ tab to reach the contact tracing window.

 

Step 3: Click on the 'Edit' tab and fill in the relevant information in the fields provided.

 

 

Step 4: Once the details are entered, click on the ‘update’ tab present at the upper right corner of the window to finish the process. A message will be displayed by the system once the details are updated successfully.

 

 

Step 5: Once the details are updated successfully, an option to add the contact will appear at the upper right corner of the contact tracing window. This option can be used to add contacts as Beneficiaries (Presumptive TB/ TB Preventive Treatment (TPT) beneficiaries) in the system.

 

 

Step 6: Selecting the 'Add contact' tab will take the user to the enrollment window. The process of entering information in this window is similar to adding a New presumptive TB case in Ni-kshay, except that the option of “Contact of Known TB Patient” is automatically selected for the field “Key Population”.

Once the contact is added as a beneficiary (Presumptive TB/ TPT beneficiary) in the system, the contact details can be seen in the contact tracing tab.

Video: Recording Contact tracing in Ni-kshay (Web)

 

 

Video: Recording Contact tracing in Ni-kshay (Mobile App)

 

Resources

• Contact Tracing, Ni-kshay Knowledhge Base, Ni-kshay Zendesk.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Pre-test​
Contact tracing plays an important role in the detection of all those who are secondarily infected.	False	True			2	Contact tracing plays an important role in the detection of all those who are secondarily infected for proper diagnosis and prompt treatment.		Yes	Yes