Application of a TB care cascade to a novel household contact intervention in rural South Africa

Four clinics implemented an intervention to increase TB household contact identification and evaluation in rural Eastern Cape, South Africa. We applied a care cascade framework to assess gaps in evaluation and treatment initiation from April 2021 to June 2023. We identified 1,698 contacts of 287 individuals with TB. The majority of contacts (71%) were screened; 9% of those with symptoms were fully evaluated, and of these, 14% were diagnosed with active TB. This intervention substantially increased TB contact identification and evaluation compared to prior efforts in the same area; however, additional barriers limited the ability to identify and treat secondary cases.