# Innovative contact tracing strategies for detecting TB in mobile rural and urban South African populations

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2020 · $587,975

## Abstract

PROJECT SUMMARY
Although largely a curable disease, tuberculosis (TB) remains the leading cause of death in South Africa and
the leading single-agent infectious cause of death globally. Nevertheless, over one-third of people with TB – an
estimated 3.6 million people worldwide – are never notified to health authorities. The demographic group at
greatest risk for TB and also responsible for the majority of TB transmission consists of working-age adults
(especially men). These individuals are often highly mobile, making it difficult to engage them with traditional
TB case-finding activities such as screening at healthcare facilities or household contact investigation during
business hours. Their patterns of movement, however, are highly regularized throughout sub-Saharan Africa
and the rest of the world: young adults migrate to cities for work and travel home to rural homelands to visit
families during the holidays. These predictable patterns of movement create an opportunity for innovative
interventions to engage this high-risk, mobile population that bears a tremendous burden of undiagnosed TB
and continues to fuel transmission in many communities. Specifically, mobile young adults can be found at
their urban homes during non-working hours (on evenings and weekends) and visiting their families in rural
settings during holiday times. Although most TB transmission occurs outside of households, household
members of individuals diagnosed with TB remain the highest-risk population that can be identified, outside of
congregate living settings (e.g., prisons). There is therefore no better place to look for the “missing 3.6 million”
TB cases than in these households. We propose a randomized trial of two novel TB case-finding interventions
among household members of patients diagnosed with active TB: holiday-based screening in a rural South
African province (Limpopo) and off-peak (weekend/evening) screening in an urban settlement into which many
residents of Limpopo migrate for work. We will enroll 2400 index cases of TB plus an estimated 4800
household contacts in each setting (7200 participants per setting, 14400 participants overall) and randomize
them to novel versus standard contact investigation. In Specific Aim 1, we will use whole genome sequencing
of all cases, overlaying transmission trees with data on human movement, to evaluate associations between
mobility and TB transmission in this population. In Specific Aim 2, we will employ a multidisciplinary approach
to compare novel versus standard contact investigation in each setting along the following dimensions: (a)
effectiveness (number of secondary TB cases diagnosed and starting treatment); (b) implementation (reach,
fidelity, and maintenance of contact investigation outside of business hours); (c) cost-effectiveness (cost per
disability-adjusted life year) and budget impact; and (d) projected population-level impact on TB incidence.
Successful completion of these aims will have long-term impac...

## Key facts

- **NIH application ID:** 9989776
- **Project number:** 5R01AI147681-02
- **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:** $587,975
- **Award type:** 5
- **Project period:** 2019-08-07 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9989776

## Citation

> US National Institutes of Health, RePORTER application 9989776, Innovative contact tracing strategies for detecting TB in mobile rural and urban South African populations (5R01AI147681-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9989776. Licensed CC0.

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