TY - JOUR
T1 - Feasibility of identifying household contacts of rifampinand multidrug-resistant tuberculosis cases at high risk of progression to tuberculosis disease
AU - Gupta, Amita
AU - Swindells, Susan
AU - Kim, Soyeon
AU - Hughes, Michael D.
AU - Naini, Linda
AU - Wu, Xingye
AU - Dawson, Rodney
AU - Mave, Vidya
AU - Sanchez, Jorge
AU - Mendoza, Alberto
AU - Gonzales, Pedro
AU - Kumarasamy, Nagalingeswaran
AU - Comins, Kyla
AU - Conradie, Francesca
AU - Shenje, Justin
AU - Fontain, Sandy Nerette
AU - Garcia-Prats, Anthony
AU - Asmelash, Aida
AU - Nedsuwan, Supalert
AU - Mohapi, Lerato
AU - Lalloo, Umesh G.
AU - Ferreira, Ana Cristina Garcia
AU - Mugah, Christopher
AU - Harrington, Mark
AU - Jones, Lynne
AU - Cox, Samyra R.
AU - Smith, Betsy
AU - Shah, N. Sarita
AU - Hesseling, Anneke C.
AU - Churchyard, Gavin
N1 - Funding Information:
Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Mental Health (NIMH), UM1AI068634, UM1AI068636, UM1AI106701, UM1A1068616, UM1AI068632, UM1AI068616 and UM1AI106716), and the NICHD contract number HHSN275201800001I. A. G. and S. C. are supported by the National Institute of Allergy and Infectious Diseases (grant number UM1AI069465).
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background. We assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial. Methods. We conducted a cross-sectional study of adult MDR-TB cases and their HHCs in 8 countries with high TB burdens. HHCs underwent symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing. Results. From October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were positive for acid-fast bacilli sputum smears and 43% had cavitary disease; at study entry, 35% remained smear positive after a median MDR-TB treatment duration of 8.8 weeks. There were 9 HHCs that were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. There were 121 (12%) HHCs that had new cases of TB identified: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) were aged <5 years; 63 (6%) were aged .5 and were infected with HIV; and 610 (61%) were aged ≥5 years, were negative for HIV or had an unknown HIV status, and were TBI positive. Only 21 (2%) HHCs were on preventive therapy. Conclusions. The majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel, preventive therapies are urgently needed to inform treatment policy and practice.
AB - Background. We assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial. Methods. We conducted a cross-sectional study of adult MDR-TB cases and their HHCs in 8 countries with high TB burdens. HHCs underwent symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing. Results. From October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were positive for acid-fast bacilli sputum smears and 43% had cavitary disease; at study entry, 35% remained smear positive after a median MDR-TB treatment duration of 8.8 weeks. There were 9 HHCs that were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. There were 121 (12%) HHCs that had new cases of TB identified: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) were aged <5 years; 63 (6%) were aged .5 and were infected with HIV; and 610 (61%) were aged ≥5 years, were negative for HIV or had an unknown HIV status, and were TBI positive. Only 21 (2%) HHCs were on preventive therapy. Conclusions. The majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel, preventive therapies are urgently needed to inform treatment policy and practice.
KW - Household contacts
KW - Multidrug-resistant tuberculosis
KW - Preventive therapy
KW - TB disease
KW - TB infection
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U2 - 10.1093/cid/ciz235
DO - 10.1093/cid/ciz235
M3 - Article
C2 - 30942853
AN - SCOPUS:85071983964
SN - 1058-4838
VL - 70
SP - 425
EP - 435
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -