Non-Communicable Disease and Depressive Symptoms Among Participants of the Kharituwe Case Finding Trial

BACKGROUND South Africa has a high burden of non-communicable diseases (NCDs). Routine screening remains low, care-seeking is often delayed, and many individuals remain undiagnosed. Contact investigation for tuberculosis (TB) represents an opportunity to screen for NCDs as well, but the prevalence of NCDs among index participants (IPs) diagnosed with tuberculosis and their household contacts (HHCs) is not well known. METHODS We conducted a secondary data analysis within the Kharituwe TB case-finding trial. We calculated the prevalence of self-reported diabetes mellitus (DM), cardiovascular disease, Chronic Obstructive Pulmonary Disease (COPD)/Asthma, and depressive symptoms. Among adults, we used mixed-effects logistic regression models to evaluate associations with participant characteristics. RESULTS Kharituwe TB enrolled 10,579 participants: 4,417 IPs and 6,162 HHCs. Overall, 10.2% (n = 450) IPs reported an NCD. Self-reported prevalence among IPs and HHCs, respectively, was 7.0% and 7.2% for cardiovascular disease, 2.5% and 1.3% for DM, 0.8% and 0.7% for asthma/COPD, and 18.4% and 4.8% for depressive symptoms. Odds of self-reported DM [adjusted OR: 2.03 (95% CI: 1.41, 2.90)] and depressive symptoms [adjusted OR: 2.31(95% CI: 1.95–2.74)] were twice as high in IPs as in HHCs. There was notable geographical variation in the prevalence of self-reported depressive symptoms and cardiovascular disease. CONCLUSION There was a modest prevalence of depressive symptoms among people diagnosed with TB. The relatively low prevalence of self-reported NCDs may indicate underdiagnosis. Integrating NCD screening into community-based interventions like active case finding for TB may offer a high-yield opportunity to facilitate early NCD diagnosis. TRIAL REGISTRATION The Kharituwe TB contact tracing study was registered on ClinicalTrials.gov (Identifier NCT04520113) on August 20th, 2020.