Studies highlight the role of home visits, chest radiography, and sputum monitoring in TB prevention and treatment outcomes.
Pulmonary Tuberculosis Chest X-ray : interstitial infiltration at left upper lung due to Mycobacterium Tuberculosis infection
Image credits: Unsplash
A pilot project in Uganda, running from November 2023 to September 2024, sought to address the challenges of suboptimal tuberculosis (TB) case finding and preventive treatment (TPT) coverage among household contacts (HHCs) of individuals with pulmonary TB. The project, which enrolled 521 index patients with TB and 1,913 household contacts across six health facilities, was featured in the CDC MMWR on March 20, 2025, highlighting the success of innovative methods in TB management. These methods, including home visits, chest radiography (CXR), and enhanced TPT delivery, have the potential to improve TB case detection and prevention, particularly in high-incidence areas like Uganda.1
Household contacts of TB patients are at heightened risk due to prolonged exposure to infected individuals. Despite global calls to improve TB diagnosis and prevention, TB case finding and TPT use among household contacts remain inadequate. In 2023, global TPT use among HHCs was reported at 21%, which is far below the expected coverage. This pilot project aimed to improve TB detection and TPT initiation by employing home visits, comprehensive screening, and support services.1
Of the 1,913 household contacts screened, 90.9% were assessed for TB symptoms. Of these, 18.5% reported symptoms suggestive of TB. Further clinical evaluation and CXR led to the identification of 80 new TB cases, with 61 of these cases diagnosed based on radiographic findings alone. This highlights the role of CXR in detecting asymptomatic TB, with 3.1% of previously asymptomatic contacts found to have TB detectable by CXR.1
Preventive treatment was offered to 1,496 eligible HHCs. Of these, 82.8% initiated TPT, and 95.1% completed it, with no severe adverse reactions reported. The high adherence to short-course preventive regimens underscores the effectiveness of using shorter treatment courses, which have been shown to increase patient compliance compared to traditional longer regimens. Furthermore, the median time from the registration of the index patient to the first home visit was 1 day, and the median duration for initiating TPT was 2 days, indicating a prompt response and efficient delivery of preventive care.1
The success of this project is an encouraging step towards meeting global TB control goals, including the End TB Strategy, which aims to reduce TB incidence by 90% by 2030. Challenges such as incomplete coverage of asymptomatic individuals and the absence of control sites limit the generalizability of the results. Despite limitations, the approach shows promise in scaling up TB case finding and preventive treatment, particularly in high-incidence areas like Uganda.1
This pilot project complements findings from a recent study on TB/HIV co-infection in East and North Eastern Uganda, which revealed a treatment success rate of 71.9% among patients co-infected with TB and HIV. Published in Scientific Reports, the study involved 324 patients treated from July 2019 to July 2021 at three regional referral hospitals. The study defined treatment success as completing therapy, with or without bacteriologic confirmation, and highlighted key factors affecting treatment success, including loss to follow-up (12%) and mortality (9.9%).2
A pilot project in Uganda identified 80 new TB cases, with 61 cases diagnosed through chest radiography.
The project achieved an 82.8% initiation and 95.1% completion rate for preventive treatment.
A study on TB/HIV co-infection found that lack of sputum monitoring reduced treatment success.
The study also emphasized the importance of sputum monitoring during treatment. Patients who lacked sputum monitoring at five months were less likely to achieve treatment success (adjusted relative risk: .48).2
Both studies contribute to Uganda's TB control efforts by improving case detection, preventive treatment, and treatment adherence. The pilot project demonstrates the impact of home visits, chest radiography, and short-course TPT in identifying and preventing TB among household contacts. The TB/HIV study highlights the importance of sputum monitoring and follow-up to improve treatment success rates. These findings support targeted strategies to reduce TB incidence and enhance patient outcomes in high-burden settings.
