From Lessons to Action: Expanding TB Contact Investigation across Five Afghanistan Provinces
The primary goal of the Challenge TB (CTB) project in Afghanistan is to assist the NTP to reach its strategic objective of increasing TB case notifications by at least 8% annually through comprehensive TB care and prevention activities. The contact investigation of source TB cases resulted in the identification and diagnosis of TB cases and the initiation of preventive medicine to children under the age of five. Prior to 2014, a passive contact investigation strategy in the country produced limited results. Most of those with close contact to an infected patient could not visit health facilities, leading to poor IPT initiation and unacceptable results for children. The greatest challenge was concentrated in five of the most populated provinces in Afghanistan (Kabul, Herat, Kandahar, Nangarhar, and Balkh). The objective of the CTB project was to expand an active contact investigation strategy across the country. Contact screening (household screening) is part of the standard operating procedures (SOPs) implementation to address high risk groups and increase case notifications in the country. Active contact screening was introduced in Kabul for urban DOTS in 2014 by the TB CARE I project, and this approach was expanded to four new urban DOTS-supported cities in late 2015 and to the remaining 29 provinces in 2016 with support from the CTB project and the Global Fund, respectively. Based on available resources and NTP recommendations, CTB focused on active household contact screening of all bacteriologically confirmed TB index cases in five cities at both public and private health care facilities.