Evaluation of Contact Tracing of Index TB Cases in Murewa District, Mashonaland East Province, Zimbabwe, 2024

Abstract

WHO highlighted that in 2023, there were approximately 10.8 million TB cases globally, with a quarter of the world's population having had TB infection. In 2022, among all incident TB cases, Africa had approximately 25% of the cases, with over 33% of deaths occurring in this region (World Health Organisation, 2022). According to the WHO, in 2021 alone, Zimbabwe had an estimated 29,945 people who developed TB, and of this population, only 16,541 were diagnosed and initiated treatment. There was an estimate of 7300 deaths, which included 5300 deaths among people living with HIV Tuberculosis (TB) remains a significant public health concern in Zimbabwe, with an estimated 211 cases per 100,000 population in 2023 (WHO, 2024). Approximately 14,000 TB cases were missed nationwide due to inadequate case detection and gaps in contact tracing (MOHCC, 2021). The percentage of contacts screened for TB in Zimbabwe decreased from 92.45% in 2021 to 88.29% in 2022 (WHO, 2023). The purpose of this study is to evaluate contact tracing for index TB cases in Murewa District, Mashonaland East, Zimbabwe, from January to December 2024, focusing on treatment outcomes, Presumptive and TB yields. This study utilised a cross-sectional analysis of the 2024 drug-sensitive TB cohort to evaluate TB contact tracing in Murewa District, Zimbabwe, from January 2024 to December 2024. It utilised secondary data from TB registers and facility records, complemented by quantitative interviews with healthcare providers involved in contact tracing. The study was conducted in Murewa District health facilities, one of the nine districts in Mashonaland East Province, Zimbabwe. The study population consists of: Index TB Cases, contacts of Index TB Cases and healthcare Workers (HCWs): involved in contact tracing, TB diagnosis, and treatment follow-up in Murewa District during the study period. On treatment outcomes of TB index cases, 58% were cured, 36% completed treatment 5% died, and 1% lost to follow-up. The treatment success rate was 94%. From the total index cases, 323 contacts were listed, and 260 were screened for TB. The coverage was 80.5% with 63(19.5%) contacts missed. Despite the 0% active TB yield found in the study, the presumptive TB yield was 36.2%. Among the health workers that participated in this study, 85% were trained in contact tracing. Staff shortage was highlighted by 17 out of 20 participants with 3 participants indicated that staff shortage did not affect contact tracing efforts. There is need to strengthened data driven and targeted support and supervision especially in areas where there if high staff attrition as need arise to implement this strategy. Mobilization of resources specific to the contact tracing program is crucial to ensure that there are no missed contacts to be screened.