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Task Order 7: Use of network analysis methods to characterize M. tuberculosis transmission patterns among women and other high-risk populations

Task Order 7 assesses whether network analysis can help uncover and characterize ongoing transmission patterns among women and other high risk populations. The purpose of this project is to examine the use and practicality of social network analysis methods as a tool for improving the overall success of TB contact investigations. It is anticipated that these methods will identify women and other high-risk groups who will benefit most from TB screening services and treatment of either active disease or latent TB infection (LTBI).

Sites

Contra Costa County, CA, Dekalb County., GA, Downtown Eastside TB Clinic, Vancouver, BC

Study Objectives

1. Determine feasibility and TB programs' ability to:

  1. abstract necessary data from case and contract investigation records
  2. supplement these data with interviews about places of social aggregation
  3. elicit names of contacts from repeatedly-named contacts
  4. implement and evaluate an MS Access database for capturing all necessary data for performing network analysis
  5. assess whether network analysis using combination of case, contact, and place data can help uncover and characterize ongoing transmission

Study Design

Confirmed TB patients and their identified contacts within the designated TB control jurisdictions (Contra Costa County, Dekalb County, and Downtown Vancouver) will serve as the source of the study population. As part of standard TB control practice, each TB control program participating in this project currently has procedures in place to perform contact investigations for TB patients. The prospective observational study design will simultaneously gather data at three TBESC sites. Data for use in network analysis will be abstracted from the usual TB case and contact investigation forms currently in use at the three participating local TB control programs. Network analysis software will be used to link together and characterize the abstracted contact investigation data gathered by each site. It is anticipated that this analytic method will help prioritize persons who will benefit from TB screening services and treatment of active disease or latent TB infection (LTBI).

Study Progress

The study has been completed, data has been analyzed and presentations have been given at scientific meetings. A manuscript has been accepted for publication in the Journal of Infectious Diseases. Final enrollment was 36 cases and 205 contacts in Dekalb County, GA; 42 cases and 179 contacts in Contra Costa County, CA; and 9 cases and 76 contacts in Vancouver, BC. An important outcome of the study was that infrastructure for implementing network analysis was successfully implemented at 3 local TB control programs. Use of a brief questionnaire to collect data from cases and contacts regarding their places of social aggregation was useful in helping detect associations among cases and contacts that would have gone unrecognized in the absence of the places data. In several instances, network analysis connected TB cases earlier than genotyping data. This was likely due to very long delays (6-12 months) with lab reporting genotyping results back to states, and then state reporting to programs. "In house" network analysis empowered local TB controllers to plan their next contact tracing activities while awaiting genotyping results.

 
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