New study aims for best strategy to find recurrent cases of Tuberculosis

TB Aftermath has been underway since January 2021 in association with the National Tuberculosis Elimination Programme (NTEP). The trial will assess strategies like screening for TB during follow up visits at patients’ homes or during telephone calls, which could be cost effective and feasible to manage treated TB patients and help identify people at risk.

Worldwide, approximately 7% of all reported TB cases each year are recurrent, occurring among people who have had TB in the recent or distant past. TB recurrence is particularly common in India, which has the largest TB burden worldwide. Historical cohorts in India have shown that 10 to 13% of treated patients become ill with TB again.

Although patients recently treated for TB are at a high risk of developing TB again, evidence around effective active case finding strategies in this population is scarce, according to site principal investigator Brigadier (Dr) M S Barthwal, Head of Department of Respiratory Medicine, Dr D Y Patil Medical College, Hospital and Research Centre.

“The trial has many components, including which strategy is cost effective, whether to call people at their homes every six months or visit them. So our hypothesis is that both strategies work equally well but we are trying to look at these aspects in our study so that we are able to better manage patients, following the completion of TB treatment. We will also be able to identify what kind of care they would need and further check on their lung function post TB,” Dr Jonathan Golub, a principal investigator from Johns Hopkins University said.

In the home-based strategy, the NTEP staff from the six TB units will visit all patients at their homes at six and 12 months post the completion of their treatment.

They will administer a standardized TB symptom screen questionnaire to treated cases and their household contacts. All those who screen positive will be referred for microbiological testing at the TB unit.

As part of the telephonic strategy, healthcare workers will administer a standardized TB symptom screen questionnaire to the patient by phone at 6 and 12 months post-treatment completion. The patient will also be asked about any TB symptoms among household contacts. If TB is suspected among any of the household members, they will be referred for microbiological testing at the TB unit.

In the national strategic plan for TB , the NTEP has committed to follow-up and search for TB among individuals who have been treated for the disease. However, they have not yet defined the strategy that will be utilized.

Dr. Vidya Mave, principal investigator from Johns Hopkins University, India programme, said the study can provide an evidence base for designing strategies to identify recurrent TB. “This trial is part of the government’s effort to develop strategies to find patients who have been cured and identify, who are at most risk of a relapse,” she said.

“Identifying TB patients likely to develop recurrent disease could help target case-finding efforts and addressing modifiable risk factors could reduce the risk of recurrence. Based on the successful use of integrated clinic-community programmes, defining a clear, cost-effective strategy with a potential for scalability is the final aim,” said Dr Barthwal.