{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:09Z","timestamp":1792785849814,"version":"4.5.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"United States National Institute of Allergy and Infectious Diseases","award":["5R01AI147681"],"award-info":[{"award-number":["5R01AI147681"]}],"id":[{"id":"https:\/\/ror.org\/043z4tv69","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Household contact tracing (HHCT) is a widely recommended intervention for tuberculosis (TB) but is poorly implemented. Multidimensional poverty, encompassing deprivations in health, education, and living standards, may hinder implementation success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a cluster-randomized trial in South Africa, we examined the relationship between household multidimensional poverty as a composite deprivation score and HHCT reach as (1) initiation (at least one household contact screened); (2) continuous proportion of eligible household contacts screened; and (3) completion (all eligible household contacts screened once initiated). We performed multilevel mixed-effects modeling with modified Poisson and ordered beta regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite near-universal comfort with HHCT (97%) among 3392 households, only 43% initiated HHCT and 19% completed screening. Greater multidimensional poverty was significantly associated with lower HHCT initiation in urban households (adjusted prevalence ratio [aPR]: 0.903, 95% confidence interval [CI]: 0.831, 0.984, per 10% higher deprivation; P = .021), but not in rural households (aPR: 1.06, 95% CI: 0.99, 1.13; P = .083). Across all households, we observed a modest but statistically significant association between greater poverty and lower predicted proportion of household contacts screened (adjusted average marginal effect [aAME]: \u22121.22% [\u22122.20%, \u22120.236%], per 10% higher deprivation; P = .015). Among households that initiated HHCT, multidimensional poverty was not significantly associated with screening completion (aPR: 0.945, 95% CI: 0.865, 1.03; P = .207).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Stated comfort with HHCT may not directly translate into implementation success. Multidimensional poverty was a significant structural barrier for HHCT initiation in an urban, South African township. Once initiated, getting all household contacts screened may require targeting additional operational and health system barriers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag321","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:14:24Z","timestamp":1781612064000},"page":"e559-e568","source":"Crossref","is-referenced-by-count":0,"title":["Multidimensional Poverty and Implementation Reach of Household Contact Tracing for Tuberculosis in South Africa: Analysis of a Randomized Trial"],"prefix":"10.1093","volume":"83","author":[{"given":"Giridhar","family":"Mohan","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4544-4591","authenticated-orcid":false,"given":"Colleen 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