Death Rates

Protective impacts of household-based tuberculosis contact tracing are robust across endemic incidence levels and community contact patterns
Screening household members of newly detected tuberculosis cases is an efficient method for finding previously undiagnosed cases in high-burden settings. Despite the intuitive appeal of this approach, randomized trials examining the population-level effects of these interventions in settings with sustained community transmission have shown mixed results. One explanation for these inconclusive findings is that household transmission is responsible for a varying proportion of overall tuberculosis burden between locations, with the impact of household transmission being a function of both the overall incidence and the relative intensity of disease-transmitting contacts in the community and the household. In this manuscript, we use an individual-based network model to explore how local incidence levels and patterns of community contact impact the effectiveness of household-based approaches for interrupting tuberculosis transmission. Our analyses suggest that protective benefits of household-based interventions are maintained across a wide range of epidemiological settings. Our findings provide evidence for the robustness of household-based interventions and suggest that variable results from trials may be primarily due to implementation challenges rather than inherent limitations of these interventions.