Willingness to take multidrug-resistant tuberculosis (MDR-TB) preventive therapy among adult and adolescent household contacts of MDR-TB index cases: an international multi-site cross-sectional study.

Citation: Suryavanshi N, Murrill M, Gupta A, Hughes M, Hesseling A, Kim S, Naini L, Jones L, Smith B, Gupte N, Dawson R, Mave V, Meshram S, Mendoza A, Sanches J, Kumarasamy N, Comins K, Conradie F, Shenje J, Fountain SN, Garcia-Prats A, Asmelash A, Nedsuwan S, Mohapi U, Garcia Ferreira AC, Okeyo E, Swindells S, Churchyard G, Shah NS for the A5300/I2003 Study Team. Willingness to take multidrug-resistanat tuberculosis (MDR-TB) preventive therapy among adult and adolescent household contacts of MDR-TB index cases: An international multi-site cross-sectional study. Clin Infect Dis. 2019 Mar 28. pii: ciz254. doi: 10.1093/cid/ciz254. [Epub ahead of print] PMID: 30919881.

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https://www.ncbi.nlm.nih.gov/pubmed/30919881

BACKGROUND:
Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (TPT) to decrease their risk of TB disease.

METHODS:
In this cross-sectional study of HHCs of MDR and rifampicin resistant (RR)-TB index cases from 16 clinical research sites in eight countries, enrollees were interviewed to assess willingness to take a hypothetical, newly-developed MDR TPT if offered. In order to identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering.

RESULTS:
From 278 MDR/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 years (IQR 22-49) and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling [adjusted Odds Ratio (aOR) 1.83, 95% confidence interval (95%CI) 1.07-3.13], appropriate TB-related knowledge (aOR 2.22, 95%CI 1.23-3.99), confidence in taking TPT (aOR 7.16, 95%CI 3.33-15.42), and being comfortable telling others about taking MDR TPT (aOR 2.29, 95%CI 1.29-4.06).

CONCLUSIONS:
The high percentage of HHCs of MDR/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.

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