Resource utilization for multidrug-resistant tuberculosis household contact investigations (A5300/I2003)

Citation: Swindells S, Gupta A, Kim S, Hughes MD, Sanchez J, Mave V, Dawson R, Kumarasamy N, Comins K, Smith B, Rustomjee R, Naini L, Shah NS, Hesseling A, Churchyard G for the ACTGA5300/IMPAACT 2003 PHOENIx Feasibility Study Team. Resource utilization for multidrug-resistant tuberculosis household contact investigations (A5300/I2003). Int J Tuberc Lung Dis. 2018 Sep 1;22(9):1016-1022. doi: 10.5588/ijtld.18.0163. PMID: 30092866 PMCID. PMC6104641 [Available on 2019-03-01]. 

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https://www.ncbi.nlm.nih.gov/pubmed/30092866

BACKGROUND:
Current guidelines recommend evaluation of the household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB); however, implementation of this policy is challenging.

OBJECTIVE:
To describe the resource utilization and operational challenges encountered when identifying and characterizing adult MDR-TB index cases and their HHCs.

DESIGN:
Cross-sectional study of adult MDR-TB index cases and HHCs at 16 clinical research sites in eight countries. Site-level resource utilization was assessed with surveys.

RESULTS:
Between October 2015 and April 2016, 308 index cases and 1018 HHCs were enrolled. Of 280 index cases with sputum collected, 94 were smear-positive (34%, 95%CI 28-39), and of 201 with chest X-rays, 87 had cavitary disease (43%, 95%CI 37-50) after a mean duration of treatment of 8 weeks. Staff required 512 attempts to evaluate the 308 households, with a median time per attempt of 4 h; 77% (95%CI 73-80) of HHCs were at increased risk for TB: 13% were aged <5 years, 8% were infected with the human immunodeficiency virus, and 79% were positive on the tuberculin skin test/interferon-gamma release assay. One hundred and twenty-one previously undiagnosed TB cases were identified. Issues identified by site staff included the complexity of personnel and participant transportation, infection control, personnel safety and management of stigma.

CONCLUSION:
HHC investigations can be high yield, but are labor-intensive.

International Journal of Tuberculosis and Lung Disease

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