Introduction

Myanmar is one of 30 high burden countries for TB, MDR-TB and TB/HIV coinfection according to WHO Global Tuberculosis report 2016. Estimated TB incidence rate was 361/100,000 population in 2016 and National TB Programme notified 139,625 TB cases in 2016 and 132,025 TB cases in 2017. Regarding with MDR-TB, the latest drug resistance survey in 2013 estimated MDR-TB prevalence of 5% among new TB cases and 27.1% among retreatment TB cases. Regarding TB/ HIV co-nfection, 8.5% of total TB cases were co-infected with HIV.
In order to reduce TB/MDR-TB burden in Myanmar, National Tuberculosis Programme (NTP) is accelerating TB/MDR-TB control activities together with partner organizations in line with the National TB Strategic Plan (2016-2020).
Among the TB/MDR-TB control activities of NTP, TB case finding is a crucial component. Among the TB case finding activities, investigating the contacts of infectious TB/MDR-TB patients have been found to be cost effective and important. It contributes to early identification of active TB, thus decreasing its severity and reducing transmission to others and identification of latent TB infection. WHO also strongly recommended that contact investigation should be conducted when the index TB patient is bacteriologically confirmed PTB, DR-TB, PLHIV and less than 5 years old of age. Normally, children do not have highly infectious form of TB. However, childhood TB cases less than 5 years old of age is in the list of index TB patient. The reason is to find the source of the infection, not to find secondary cases from the child as the infection is more possible from a person in the same household. Moreover, TB patient with HIV also contains in the list of index TB patient as there is higher likelihood that people staying in the same household also have HIV infection and are at high risk for the development active TB if infected.
Regarding with the risk for developing active TB disease, contacts have higher risk to develop active TB disease than the general population. Then, the risk is much higher if the contacts are under 5 years of age and HIV positive. According to systematic review and meta-analysis that was done by Fox G et al in 2012, prevalence of active TB disease is 3.1% among all contacts and it is 3.6% in household contacts. Prevalence of active TB disease in contacts is increased up to 4.5 – 5.5% if index patient is sputum smear positive PTB and MDR-TB. Then, prevalence of active TB disease reaches to 9.6% if contacts are < 5-year children and it reaches to 28.4% if contacts are HIV infected. Therefore, WHO also recommended that TB-CI should be conducted in low and middle income countries.
Furthermore, contact investigations also provide preventive benefit, especially for young children contacts < 5 year and HIV infected contacts who do not have active TB disease are eligible for Isoniazid Preventive Therapy (IPT). IPT could reduce the development of active TB disease from latent TB infection (LTBI) in those contacts.
TB contact investigation activity should be carried out in resource limited settings including Myanmar. Although the National TB Strategic Plan has mentioned to implement CI activities across the country, there is no detailed standard operating procedure (SOP) and guidelines for contact investigations yet. It leads to inconsistencies in quality and inability to quantify efforts and achievements of CI activities. Therefore, this SOP will address the gap of the current situation of CI activities in Myanmar. This SOP will focus not only on contact investigations of household contacts but also on close contacts. Then the SOP will provide operating procedure for both household contacts and close contacts investigation.