{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:37:08Z","timestamp":1788244628823,"version":"build-2803163510"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007137","name":"Helse Nord RHF","doi-asserted-by":"publisher","award":["To be provided later"],"award-info":[{"award-number":["To be provided later"]}],"id":[{"id":"10.13039\/501100007137","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to improve uptake.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Between May and December 2014, we randomised patient with TB who consented to participate in the trial to either standard of care (SOC) or intervention (PACTS) arms. Participants randomised to PACTS received one screening\/triage tool (adapted from WHO integrated management of adolescent and adult illnesses [IMAI] guidelines) and sputum pots for each reported household contact. The tool guided participants through symptom screening; TPT (6-months of isoniazid) eligibility; and sputum collection for contacts. Patients randomised to SOC were managed in accordance with national guidelines, that is, they received verbal instruction on who to bring to clinics for investigation using national guidelines.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Main outcome and measures<\/jats:title>\n<jats:p>The primary outcome was the proportion of adult contacts receiving treatment for TB within 3 months of randomisation. Secondary outcomes were the proportions of child contacts under age 5 years (U5Y) who were commenced on, and completed, TPT. Data were analyzed by logistic regression with random effects to adjust for household clustering.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Two hundred and fourteen index TB participants were block-randomized from two sites (107 PACTS, reporting 418 contacts; and 107 SOC, reporting 420 contacts). Overall, 62.8% of index TB participants were HIV-positive and 52.1% were TB culture-positive. 250 otherwise eligible TB patients declined participation and 6 households (10 PACTS, 6 SOC) were lost to follow-up and were not included in the analysis. By three months, nine contacts (PACTS: 6, [1.4%]; SOC: 3, [0.7%]) had TB diagnosed, with no difference between groups (adjusted odds ratio [aOR]: 2.18, 95% CI: 0.60\u20137.95). Eligible PACTS contacts (37\/96, 38.5%) were more likely to initiate TPT by 3-months compared to SOC contacts (27\/101, 26.7%; aOR 2.27, 95% CI: 1.04\u20134.98). U5Y children in the PACTS arm (47\/81 58.0%) were more likely to have initiated TPT before the 3-month visit compared to SOC children (36\/89, 41.4%; aOR: 2.31, 95% CI: 1.05\u20135.06).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions and relevance<\/jats:title>\n<jats:p>A household-centred patient-delivered symptom screen and IPT eligibility assessment significantly increased timely TPT uptake among U5Y children, but did not significantly increase TB diagnosis. This model needs to be optimized for acceptability, given low participation, and investigated in other low resource settings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Clinical trial registration<\/jats:title>\n<jats:p>TRIAL REGISTRATION NUMBER: ISRCTN81659509 <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN81659509?q=&amp;filters=conditionCategory:Respiratory,recruitmentCountry:Malawi,ageRange:Mixed&amp;sort=&amp;offset=1&amp;totalResults=1&amp;page=1&amp;pageSize=10&amp;searchType=basic-search\" xlink:type=\"simple\">https:\/\/www.isrctn.com\/ISRCTN81659509?q=&amp;filters=conditionCategory:Respiratory,recruitmentCountry:Malawi,ageRange:Mixed&amp;sort=&amp;offset=1&amp;totalResults=1&amp;page=1&amp;pageSize=10&amp;searchType=basic-search<\/jats:ext-link>. 19 July 2012.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0269219","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T17:29:31Z","timestamp":1662658171000},"page":"e0269219","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":25,"title":["Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7025-4992","authenticated-orcid":true,"given":"Kruger","family":"Kaswaswa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"MacPherson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Kumwenda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mpunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deus","family":"Thindwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marriott","family":"Nliwasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mphatso","family":"Mwapasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Odland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamiwe","family":"Tomoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Chipungu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mavuto","family":"Mukaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L.","family":"Corbett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"pone.0269219.ref001","unstructured":"2020 WHO. 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Patient and household costs associated with a tuberculosis diagnosis in Lilongwe","volume":"85","author":"JR Kemp","journal-title":"Bull World Health Organ"},{"issue":"supp 2","key":"pone.0269219.ref034","article-title":"The state of existing knowledge about TB and poverty","volume":"7","author":"B Nhlema","journal-title":"Int J Tuberc Lung Dis"},{"issue":"1","key":"pone.0269219.ref035","first-page":"65","article-title":"Developing a socio-economic measure to monitor access to tuberculosis services in urban Lilongwe, Malawi","volume":"11","author":"B Nhlema Simwaka","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0269219.ref036","volume-title":"A Systematic Analysis of TB and Poverty","author":"B Nhlema","year":"2003"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269219","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T17:30:24Z","timestamp":1662658224000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269219"}},"subtitle":[],"editor":[{"given":"Richard John","family":"Lessells","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,8]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0269219","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,8]]}}}