Despite having been recommended by the World Health Organization (WHO) since 2006, and repeatedly thereafter(1–6), contact tracing for multidrug resistant tuberculosis (MDRTB), remains a low priority within national TB programs in many low and middle-income countries where TB burden is high. In 2017, only a quarter of the estimated 558,000 rifampicin resistant and multidrug resistant tuberculosis (RR/MDRTB) cases worldwide were enrolled on effective treatment, with many dying even before a diagnosis could be made(7). Significant improvement in MDRTB case ascertainment is essential to meet the END-TB strategy targets on reducing TB incidence and mortality(6,7). Observational data in support of the need to provide treatment for latent TB infection (LTBI) presumed to be MDR is gradually accumulating(8,9) and three randomised controlled trials of preventive therapy for MDR exposed contacts are now underway(10–12).
Meta analyses of MDRTB contact tracing studies have shown that 41.3–61.3% of household contacts have latent TB infection, and that 3.4–6.5% develop active disease(13–15). Despite significant heterogeneity in the studies included in these systematic reviews they have consistently identified a substantial yield of secondary tuberculosis cases among household and close contacts. Most secondary cases tested also had MDR and were diagnosed shortly after the index case.(14)
The WHO has developed a set of global recommendations for TB contact investigation and these encourage the use of a set of standardised approaches to programme monitoring and evaluation. Heterogeneity of data collection between centres of clinical definitions and in datasets collected by various agencies remain a barrier to effective global monitoring. Whilst the WHO guidelines include precise definitions of index cases, close contacts and household contacts(5,16,17), a minimum dataset for an MDRTB contact registry has yet to be internationally agreed(9,18) and no agency currently provides support in the form of data collection tools through which such a dataset could be uniformly collected, aggregated, analysed and disseminated.
A variety of electronic TB registries and surveillance systems have been reported in recent years, including ETR.net (www.etrnet.info), ENRS (ccs.gov.eg/ntp/M_E_ENRS.htm), and e-TB manager (etbmanager.org/)(19,20).
Open Data Kit (ODK, https://opendatakit.org) is a free open source data collection toolkit allowing developers to design forms for an android application (app) ODK collect. Working in Botswana, Ha and colleagues developed an electronic data collection (EDC) solution based on ODK and used this to facilitate screening of TB contacts during household visits(21). They concluded that using ODK reduced the time taken to complete tracing for each contact and scored favourably for user satisfaction among the health workers who conducted the tracing(21).
Paper based methods remain the standard approach in those few countries which currently undertake any MDRTB contact tracing with or without subsequent surveillance. Very few studies have evaluated the feasibility and acceptability of EDC tools in these countries(22). Where these have been addressed, data accuracy and completeness remain an issue and none of this work has been completed in MDRTB contact tracing(23,24). In this study we aimed to evaluate the feasibility of a novel mobile electronic data collection tool for the building of a web-based MDRTB contact e-registry, and we collected descriptive epidemiological data on contacts.
The study was carried out in Mongolia, where in 2017 the estimated incidence rate then was 428/100,000 with a TB disease notification rate of 136/100,000, and a case detection rate of 32%(25). 12.6% of laboratory confirmed cases were MDR(26). MDRTB contact tracing has been national policy since 2006, though implementation is patchy. In 2016, 5.7% of identified household contacts developed active TB(26). Contact tracing is done through district dispensaries where patients receive directly observed treatment (DOT).