Phone-based screening versus home-based screening after tuberculosis in India (TB Aftermath): a multicentre, open-label, randomised, controlled, non-inferiority trial.
Samyra R Cox, Abhay Kadam, Shahanara Valawalkar et al.
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In 30 seconds
This multicentre, open-label, randomised non-inferiority trial compared phone-based with home-based symptom screening after tuberculosis treatment in survivors and their household contacts in Maharashtra, India. During 12 months, tuberculosis was detected in 41 events in the phone group and 64 in the home group; the rate difference was 0·73 per 100 person-years (95% CI 0·05–1·41), meeting the prespecified non-inferiority criterion. However, recurrence detection among survivors was lower with phone screening, while detection rates among contacts were similar. The findings indicate that screening modality may matter differently for survivors and contacts.
Key findings
- Overall tuberculosis detection was 1·19 per 100 person-years with phone screening and 1·92 with home screening; the rate difference was 0·73 (95% CI 0·05-1·41), meeting non-inferiority.
- Among survivors, recurrence detection rates were 4·36 (95% CI 2·87-6·34) with phone screening and 8·00 (5·90-10·60) with home screening (p=0·01).
- Among household contacts, detection rates were 0·61 (95% CI 0·32-1·07) with phone screening and 0·70 (0·39-1·20) with home screening (p=0·70).
- Tuberculosis was detected in 75 (7%) survivors and 30 (1%) household contacts during the 12-month post-treatment period.
Why it matters
The trial addresses how to screen households after tuberculosis treatment, when survivors and contacts remain at risk. Although phone-based screening met the overall non-inferiority criterion, the lower recurrence detection rate among survivors suggests that an aggregate result may not capture differences between household members. These findings help frame screening choices in settings where post-treatment recurrence is a concern.
What to keep in mind
Follow-up was limited to 12 months, and the trial enrolled survivors from six public clinics in Maharashtra, India, which may limit applicability to other settings.