Contact tracing: Progress towards the End TB strategy has been slow and unless implementation of effective interventions such as active case finding and TPT are scaled-up, we will not reach such ambitious targets. Active case finding is a key pillar of TB control however adoption of effective interventions such as contact investigation has been sub-optimal. Reliance on symptom-based TB screening is resulting in ‘missed cases’ with early evidence suggests that a universal testing approach might be more suitable in high burden/high risk populations. Limited evidence to support its adoption including cost-effectiveness. Contacts of TB patients are considered high risk for developing TB and screening/testing and TPT is a priority. Simplified algorithms for testing and starting TPT is urgently required to reach “Find. Treat. All” initiative targets.
Challenges with TPT uptake especially in child contacts and there is a need to make it easier for HCWs and programmes broadly. Understanding transmission dynamics in high burden settings will help make interventions more efficient – how far should contact tracing be extended is not known. The contribution of the household exposure versus community to overall transmission is not known and will help to optimize contact investigation.