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Vikela Ekhaya: a novel, community-based, tuberculosis contact management program in a high burden setting.

BACKGROUND: The prevention of tuberculosis (TB) in child contacts of TB cases and people living with HIV is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT.

METHODS: Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases, by utilizing mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants' homes.

RESULTS: In total, 945 contacts from 244 households were screened for TB symptoms; 72 (8%) contacts reported TB symptoms, and five contacts (0.5%) were diagnosed with prevalent TB. 322 of 330 (98%) eligible asymptomatic household contacts initiated TPT. Of 322 contacts initiating TPT, 248 children initiated 3 months of isoniazid and rifampicin and 74 children and adults living with HIV initiated 6 months of isoniazid; 298 (93%) completed TPT. In clustered logistic regression analyses, unknown HIV status (aOR 5.7, p = 0.023), positive HIV status (aOR 21.1, p = 0.001), urban setting (aOR 5.6, p = 0.006), and low income (aOR 5.9, p =0.001) predicted loss from the cascade of care among TPT eligible contacts.

CONCLUSION: Vikela Ekhaya demonstrated that community-based TB household contact management is a feasible, acceptable and successful strategy for TB screening and TPT delivery. The results of this study support the development of novel, differentiated, community-based interventions for TB prevention and control.

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