Background:

The tracing and screening of people who have had contact with an active case of tuberculosis (TB) is an important element of TB control strategies.

Objectives:

This study aimed to carry out a review of evidence regarding TB contact tracing, with a particular emphasis on research that was applicable to TB contact tracing in specific population groups in the UK.

Design:

An evidence synthesis of literature of any study design on TB contact tracing in developed countries was carried out.

Setting:

Any setting.

Population:

Individuals found to have active TB disease, and people who have come into contact with them.

Interventions:

Contact-tracing investigations.

Main outcome measures:

Any outcome related to TB infection, contact investigations and/or the views of staff, people with TB disease, or their contacts.

Data sources:

Searches for research published 1995 onwards were undertaken in the following databases: MEDLINE via Ovid SP, EMBASE via Ovid SP, EconLit via Ovid SP, PsycINFO via Ovid SP, Social Policy and Practice via Ovid SP, Cumulative Index to Nursing and Allied Health Literature via EBSCOhost, Science and Social Science Citation Indices via Web of Science and The Cochrane Library via Wiley Online Library.

Review methods:

The study comprised a review of TB contact tracing in specific population groups and a review in wider populations. A narrative synthesis was completed and a logic model was developed from the literature.

Results:

There were 112 articles in the review: 23 related to specific populations and 89 related to wider populations. The literature was of limited quality, with much general description of investigations. We identified only two (uncontrolled) studies that could be considered evaluative. Although the limitations of the evidence should be recognised, the review suggested the following: the value of a location-based approach, working with local communities and the media, partnership working, using molecular epidemiological testing, ensuring adequate systems and addressing fear of stigma. The literature on investigations for specific populations has much concordance with that reporting findings from wider population groups. The recognised limitations of conventional investigation methods may, however, be exacerbated in specific populations.

Limitations:

The English-language inclusion criterion may have limited the breadth of countries represented. A meta-analysis was not possible owing to the nature of the literature. Relevant studies may have been missed by our searches, which used terminology relating to contact tracing rather than to active case finding or screening.

Conclusions:

The review identified a sizeable volume of literature relating to contact investigations. However, it is currently predominantly descriptive, with little evaluative work underpinning investigations in either specific or wider populations. Our findings are, therefore, based on limited evidence. Further research is required if robust conclusions are to be made.

Future work:

Research should further explore the development of measures that can be used to compare the effectiveness of different contact investigations, in studies using evaluative designs.

Funding:

The National Institute for Health Research Health Services and Delivery Research programme.

Article history

The research reported here is the product of a HS&DR Evidence Synthesis Centre, contracted to provide rapid evidence syntheses on issues of relevance to the health service, and to inform future HS&DR calls for new research around identified gaps in evidence. Other reviews by the Evidence Synthesis Centre are also available in the HS&DR journal. The research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 13/05/12. The contractual start date was in October 2015. The final report began editorial review in May 2016 and was accepted for publication in September 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.

Declared competing interests of authors

none