Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Multidimensional Poverty and Implementation Reach of Household Contact Tracing for Tuberculosis in South Africa: Analysis of a Randomized Trial.
Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHousehold contact tracing (HHCT) is a widely recommended intervention for tuberculosis (TB) but is poorly implemented. Multidimensional poverty, encompassing deprivations in health, education, and living standards, may hinder implementation success.
methodsUsing a cluster-randomized trial in South Africa, we examined the relationship between household multidimensional poverty as a composite deprivation score and HHCT reach as (1) initiation (at least one household contact screened); (2) continuous proportion of eligible household contacts screened; and (3) completion (all eligible household contacts screened once initiated). We performed multilevel mixed-effects modeling with modified Poisson and ordered beta regression.
resultsDespite near-universal comfort with HHCT (97%) among 3392 households, only 43% initiated HHCT and 19% completed screening. Greater multidimensional poverty was significantly associated with lower HHCT initiation in urban households (adjusted prevalence ratio [aPR]: 0.903, 95% confidence interval [CI]: 0.831, 0.984, per 10% higher deprivation; P = .021), but not in rural households (aPR: 1.06, 95% CI: 0.99, 1.13; P = .083). Across all households, we observed a modest but statistically significant association between greater poverty and lower predicted proportion of household contacts screened (adjusted average marginal effect [aAME]: -1.22% [-2.20%, -0.236%], per 10% higher deprivation; P = .015). Among households that initiated HHCT, multidimensional poverty was not significantly associated with screening completion (aPR: 0.945, 95% CI: 0.865, 1.03; P = .207).
conclusionsStated comfort with HHCT may not directly translate into implementation success. Multidimensional poverty was a significant structural barrier for HHCT initiation in an urban, South African township. Once initiated, getting all household contacts screened may require targeting additional operational and health system barriers.
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