Effective TB Interviewing for Contact Investigation: Self-Study Modules
The most important part of the TB interview is identifying priority contacts and obtaining information about congregate settings in which transmission may have occurred. While seemingly straightforward, patients do not always readily do this, particularly if lifestyle characteristics are different from the local culture.
- Nontraditional Living Circumstances
- If the patient has contacts within a living arrangement that is different from a “mainstream” situation, he or she may be less willing to share this information. For example, a patient who lives in a joint family (e.g., multiple families living in the same household), may not want to reveal this information. It is up to the interviewer to restate the importance of identifying all priority contacts to protect their health. To obtain information about all household contacts, the interviewer must ask about all people who live in the house, whether these are nonimmediate family members, distant relatives, or friends.
- A patient’s “partner” or “significant other” may not be someone the person is married to, even if he or she lives in the same household. A partner or significant other may also be of the same sex as the patient. The interviewer should be sensitive to a variety of living arrangements and sexual orientations and ask questions with this in mind. The interviewer should ask about a “spouse or partner” when eliciting priority contacts, not assuming the sex or marital status of these individuals.
- Non-United States Resident Contacts
Information about contacts exposed during the entire infectious period should be collected, even if the contacts are not in the country during the time of the interview. The health department protocols for follow-up of contacts outside the United States should be followed in this case.
- Cultural Organizations
Contacts associated with cultural organizations (e.g., places of worship, fine arts groups, or ethnic- or language-based organizations) may be difficult to identify. Often cultural groups are support systems, and naming contacts from these groups may promote a patient’s fear of losing this support. The interviewer should emphasize why contact identification is important and that confidentiality will be maintained. The interviewer should also try to obtain the name of an individual within the cultural group who can assist with information collection about contacts and the exposure setting itself. The patient can tell the interviewer who this person would be. In some circles, a prominent or leading member of the community may need to be consulted for permission to conduct a contact investigation within that group. The patient should be consulted to determine the best approach, and if the patient wants formal permission to be obtained, this should be respected.