# Innovative Contact Tracing Strategies for Detecting TB in Mobile Rural and Urban South African Populations

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2020 · $143,847

## Abstract

Project Summary
Household contact investigation (CI) is a cornerstone of the public health response to tuberculosis (TB) in the
United States. CI is also increasingly used to find missing cases and curb transmission of other infectious
diseases, from sexually transmitted diseases to emerging infections such as the novel 2019 coronavirus. The
practice of CI, however, raises important ethical concerns. For example, disclosure of the index patient’s
disease status may be necessary to motivate participation by the household but diminishes the autonomy of
the index patient and may result in stigma. In addition, performing CI during evenings, weekends, and holidays
may increase convenience and yield and enable investigation of populations who may be key to disease
transmission and control (e.g., mobile working young men) but may also be seen as intrusive by patients and
their families. Furthermore, using CI for TB as an opportunity for HIV testing may increase efficiency but add to
the stigma attached to TB. These ethical considerations are a major reason why CI has not been more widely
implemented in many high-burden countries. The parent R01 for this Administrative Supplement is a
randomized trial of household CI of TB in South Africa, comparing CI during routine business hours to CI
during evenings and weekends in an urban province and during holiday times in a rural province. This study
offers a unique opportunity to investigate these pressing ethical considerations that must be addressed if
household CI is to succeed as a public health strategy in high TB/HIV burden settings. In this study, we will
recruit participants in the primary R01 (after follow-up for the primary outcome) to participate in a mixed-
methods investigation consisting of 300 quantitative surveys, 24 in-depth individual interviews, and six focus
group discussions (10 participants each). Quantitative surveys will draw on methods from behavioral
economics, including a discrete choice experiment, best-worst scaling survey, and contingent valuation study.
Qualitative interviews will explore themes such as stigma, disclosure, confidentiality, and both individual and
community perspectives. Both quantitative and qualitative data will be collected with an eye toward directly
addressing key ethical tensions involved in the conduct of household CI. Taken together, these investigations
will form the most comprehensive empiric evidence base to date on the ethics of household CI for TB in a high-
burden country. This research will also directly inform policy questions relating to how household CI should be
implemented and is central to the successful completion of the parent R01’s primary aims – as these ethical
issues must be addressed if any novel approach to household CI is to be successfully implemented. These
considerations were also explicitly brought up during study section review; this supplement will therefore
enable us to be responsive to those concerns. In summary, this research ...

## Key facts

- **NIH application ID:** 10130717
- **Project number:** 3R01AI147681-02S1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** David Wesley Dowdy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $143,847
- **Award type:** 3
- **Project period:** 2019-08-07 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10130717

## Citation

> US National Institutes of Health, RePORTER application 10130717, Innovative Contact Tracing Strategies for Detecting TB in Mobile Rural and Urban South African Populations (3R01AI147681-02S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10130717. Licensed CC0.

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