Effectiveness of a Home-based Approach to Child Contact Investigation and Tuberculosis Preventive Treatment Management by Community Health Workers in Ethiopia: A Pragmatic Cluster-randomized Trial

Background Tuberculosis preventive treatment (TPT) is highly effective at preventing tuberculosis (TB) disease but is poorly implemented. We aimed to determine whether home-based contact management improves TPT uptake among close child contacts compared to the facility-based standard of care. Methods We conducted a pragmatic cluster-randomized trial among close contacts of TB clients aged Results The cluster-level mean number of child contacts initiated on TPT per TB client was 40% higher in the home-based (1.7 contacts per TB client) versus facility-based arm (1.3 contacts per TB client; rate ratio 1.4, 95% confidence interval [CI]: .7-2.7). In the care continuum, assuming 2.1 children Conclusions Home-based contact management by CHWs increased the number of children initiated on TPT by 40% without negative effects on treatment outcomes. Though not statistically significant, on a larger scale, the increased number of children identified and initiated on TPT has the potential to substantially reduce the burden of pediatric TB in Ethiopia and elsewhere. Clinical trials registration NCT04369326.