TB Contact Investigation Interviewing Skills Course

After this session, participants will be able to:

1. Explain why contact assessments are conducted
2. Explain how contacts are referred for assessment
3. Explain what information needs to be obtained from a TB contact
4. Describe how to maintain confidentiality when meeting with contacts

After this session, participants will be able to:

1. Explain why contact assessments are conducted
2. Explain how contacts are referred for assessment
3. Explain what information needs to be obtained from a TB contact
4. Describe how to maintain confidentiality when meeting with contacts

• Health department referral
  • Health care worker informs the contact about exposure and the need for a medical evaluation
  • Case referral
  • Case agrees to inform the contact about exposure and the need for a medical evaluation

• The case should be given a choice of whether to inform contacts about their exposure to TB prior to health department referral process
• Discuss referral options with case

• The initial contact assessment should be within 3 working days of the contact having been identified
• Should be conducted in-person
• The investigator should use effective communication skills

[Image: Health care worker greeting a contact at the contact’s house.]

Introduce yourself and explain purpose of visit

• Ask to speak to the contact
• Verify the contact’s identity
• Ask to speak in privacy
• Inform the contact that the purpose of the visit is to discuss a health matter
• Discuss the contact’s potential exposure to TB, but maintain the case’s confidentiality

• Do not reveal the case’s name
• Use gender neutral language
• Do not mention the name of the case’s health care worker, place and dates of diagnosis, or hospitalization
• Do not reveal specific dates or environment in which exposure occurred
• Confidentiality should not be violated even if the contact refuses to be evaluated

• Inform the contact that medical evaluations may be shared with health care workers who have a “need to know”
• Assure the contact that their information will not be shared with family, friends, or others without consent
• Stress that confidentiality is reinforced by local and state policies, statutes, and/or regulations

• Provide education on TB
• Describe TB assessment process
  • Assess for TB symptoms
  • Administer TST/ IGRA or schedule an appointment
• Ask questions to gather social and medical information to assess the contact’s TB risk and further guide CI efforts
• Identify barriers to care and treatment

• Explain
  • The difference between LTBI and TB disease
  • The progression from LTBI to TB disease
  • Testing for TB infection
  • – Initial test
  • – Possibility for follow-up test
• Stress the importance of taking LTBI treatment, if needed

• Have culturally and language-specific education materials available
• Avoid using medical terms and recognize when to refer questions to appropriate personnel

During the initial assessment, all contacts with symptoms of TB disease should be medically examined immediately

[Image: A physician and a TB contact reviewing a chest x-ray.]

• Contacts should receive a TST or IGRA unless a previous, documented positive result exists
• A TST induration of 5 mm or larger is positive
• A contact with a
  • Positive TST or IGRA should  be medically examined for TB disease
  • Negative TST or IGRA should
    be re-tested 8 to 10 weeks after date of last exposure (window period)

[Image: Induration being measured with a TST ruler.]

Key information to obtain from contacts:

• Current TB symptoms (if any) and onset dates
• Previous LTBI or TB (and related treatment)
• Previous TST or IGRA results
• HIV status
  • Offer HIV testing if status unknown
• Other medical conditions or treatments that increase TB risk
• Socio-demographic factors

• The decision to test a contact should be considered a commitment to treat
• Contacts with a positive TST or IGRA should be offered LTBI treatment
  • Once TB disease is excluded
  • Regardless of whether they received BCG vaccine in the past
  • Unless there is a compelling reason not to treat
• Contacts with TB disease need to be treated under DOT

• Two-way communication is essential to ensure the contact
  • Understands the information
  • Appreciates the seriousness of the situation
• Be sure to
  • Use open-ended questions
  • Reinforce the contact’s understanding by asking him or her to explain your message

[Image: Two facilitators demonstrating how to conduct an interview for a TB contact investigation.]

Refer to Appendix U

[Image: Cartoon image of two people talking.]

1. Why are contact assessments conducted?
2. How are contacts referred for assessment?
3. What information needs to be obtained from a TB contact?
4. How can confidentiality be maintained when meeting with contacts?