Drug resistant TB burden among contacts of

drug resistant TB patients:

Results from routine program implementation
in three regions of Ethiopia
Authors: N Hiruy1, B Ayele2, Y Molla3, D Habte1, T Setargie1, G
Gizatie1, D Jerene1, M Melese4

Affiliations: 1Challenge TB (CTB) Project, Management Sciences for Health (MSH), Addis Ababa,
Ethiopia; 2Federal Ministry of Health, National TB Program, Addis Ababa, Ethiopia; 3CTB Project, KNCV
Tuberculosis Foundation, Addis Ababa, Ethiopia; 4MSH, Arlington, Virginia, United States of
America
Study setting: Ethiopia
Population: 99 Million

Among 30 HBC TB/TB/HIV & MDR-TB

countries

TB Incidence: 192 per 100,000

TB/HIV Co-infection: 8%

% of TB cases with MDR-TB: 2.7% (new),

14% (retreatment)

MDR-TB TSR: 68% (2013 cohorts)

 Background/Objective
• Systematic TB screening for contacts of drug
resistant TB (DR-TB) is a key global
recommendation.
• We present the yield of routine contact
investigation for index DR-TB cases.
 Methods
• Household contacts of index DR-TB cases were
screened for TB through health facilities and home
visits.
• The project supported:
– staff training
– preparation and distribution of guidelines & algorithms
– provision of recording/reporting forms
Drug resistant TB treatment service
Study area
- Three regions
- Jan-Mar 2016 data collected
from 34 TICs
Region TIC number
Amhara 10
Oromia 17
Tigray 7
Total 34
 Methods: Screening procedure
• Contact screening in the M(X)DR TB Index
Case
national guideline
• Regional health bureaus Contact
present
developed operational tools
• Family members/other close Yes No
contacts invited to health
Explore further
facility TB symptom
possible contacts
• Symptomatic contacts
evaluated by trained health Yes No

workers DST/GeneXpert Quarterly

sputum test follow up
MDR-TB patient counseling in a health facility
 Results
Region
Indicators Amhara Oromia Tigray Total
# of contacts screened for 155 262 40 457
TB (%, 95% CI) (100, 97.6-100) (86.2, 81.9-89.6) (100,91.2-100) (91.2,88.4-93.4)
# of contacts TB screen
positive (presumptive 2 13 15
TB)(%, 95% CI) (1.3,0.4-4.6) (5.0, 2.9-8.3) 0(0) (3.3, 2.0-5.3)
# of contacts diagnosed with 2 4 6
MDR-RR TB (%, 95% CI) (1.3, 0.4-4.6) (1.5, 0.6-3.9) 0(0) (1.3,0.6-2.8)
DR CNR/100,000 contacts 1290 1526 1313
(95% CI) (355-4582) (595-3859) 0(0) (603-2834)
• Screened 457(95%) household contacts of 169 DR-TB index cases
• Yield of DR-TB was 1.3% (1,313 DR-TB cases per 100K)
• Greater than the yield of TB among contacts of drug sensitive TB cases in the
same period  0.7% (p>0.05)
 Conclusion
• The yield of DR-TB among contacts of DR-TB
cases is:
– 7 times the TB case notification in the general population
– 1.8 times the yield of TB among contacts of DS TB index
cases
• Contacts of DR-TB cases should be routinely
screened for TB.
 Thank you
For more information, contact:
Nebiyu Hiruy, M&E Senior Advisor, CTB Ethiopia
nhiruy@msh.org