Work

Tuberculosis preventive treatment and care cascade among household contacts of patients starting tuberculosis treatment in Southern Africa: a multicountry cohort analysis

Year: 2026

Type: article

Abstract: Background Tuberculosis preventive treatment (TPT) is recommended for household contacts of tuberculosis (TB) patients, yet implementation gaps persist, particularly in high-burden settings. We evaluated the TB preventive care cascade and determinants of TPT initiation among household contacts of patients with TB across five Southern African countries.Methods In a prospective cohort study within the International Epidemiology Database to Evaluate AIDS Southern Africa (IeDEA-SA), we enrolled all individuals aged ≥ 15 years with pulmonary TB starting treatment between October 2022 and March 2023 at five TB/HIV care clinics in Malawi, Mozambique, South Africa, Zambia and Zimbabwe. We analysed the preventive care cascade of their household contacts along sequential outcomes: healthcare visit, TB symptom reporting, microbiological testing, diagnosis and TPT initiation and completion. Determinants of TPT initiation were assessed using multivariable logistic regression.Results Among 1438 index patients with TB, 1369 (95%) reported at least one household contact, yielding 5805 contacts: 4529/5805 (78%) visited a healthcare facility and 877/4529 (19%) reported current TB symptoms, 297/4529 (7%) tested for TB, which was confirmed, latent or suspected in 74/4529 (2%). Among 4455 contacts visiting a healthcare facility with no confirmed, suspected or latent TB, only 223 (5%) initiated TPT, more frequently among people with HIV (OR 3.28, 95% CI 1.78 to 6.02) and children under 5 years (OR 3.27, 95% CI 1.42 to 7.54). At study end, 137 (61%) completed TPT, 84 (38%) were still on treatment, only 1 contact interrupted treatment and 1 had unknown status.Conclusion Despite high healthcare engagement among index patients, TPT initiation among household contacts in Southern Africa was low although relatively higher among priority groups such as people with HIV and young children. Strengthening the link between household contact screening and TPT uptake is essential to close the preventive care cascade gap in the region.

Source: BMJ Global Health

DOI: 10.1136/bmjgh-2026-025497