Multidimensional Poverty and Implementation Reach of Household Contact Tracing for Tuberculosis in South Africa: Analysis of a Randomized Trial.
Giridhar Mohan, Colleen F Hanrahan, Pablo Martinez-Amezcua et al.
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In 30 seconds
This analysis of a cluster-randomized trial in South Africa examined whether household multidimensional poverty was associated with the reach of household contact tracing (HHCT) for tuberculosis. Among 3392 households, 97% reported comfort with HHCT, but 43% initiated screening and 19% completed it. Greater deprivation was associated with lower initiation in urban households (adjusted prevalence ratio 0.903, 95% confidence interval 0.831, 0.984, per 10% higher deprivation), but not in rural households. Across households, greater poverty was also associated with a modestly lower predicted proportion of contacts screened.
Key findings
- Although 97% of households reported comfort with HHCT, 43% initiated screening and 19% completed it.
- In urban households, each 10% higher deprivation was associated with lower HHCT initiation (adjusted prevalence ratio 0.903, 95% confidence interval 0.831, 0.984; P = .021).
- Across households, each 10% higher deprivation was associated with a 1.22% lower predicted proportion of contacts screened (adjusted average marginal effect -1.22% [-2.20%, -0.236%]; P = .015).
- Among households that initiated HHCT, poverty was not significantly associated with screening completion (adjusted prevalence ratio 0.945, 95% confidence interval 0.865, 1.03; P = .207).
Why it matters
The findings distinguish willingness to accept contact tracing from its actual reach: high reported comfort did not translate into widespread initiation or completion. The urban association suggests that social and material deprivation may impede access to this recommended TB intervention, while the lack of association with completion after initiation points to potentially different barriers at later stages.
What to keep in mind
The analysis identifies associations and does not establish that poverty caused lower HHCT reach. The initiation association differed between urban and rural households, limiting generalisation across settings.