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Free Content Contact investigations as a means of detection and timely treatment of persons with infectious multidrug-resistant tuberculosis

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Abstract:

SETTING: Two regions of metropolitan Lima, Peru.

OBJECTIVE: To determine the outcomes of two contact investigation strategies used in therapy enrollment cohorts of patients with multidrug-resistant tuberculosis (MDR-TB).

DESIGN: From 28 August 1996 to 31 December 1999, 91 index patients received individualized MDR-TB therapy (Group A), and from 1 October 1997 to 31 December 1999, another 101 index patients received a standardized MDR-TB regimen (Group B). We conducted a retrospective chart review and home visits to identify secondary cases among close contacts of both of these groups. Group A secondary cases with MDR-TB received therapy based on the drug susceptibility profile of their infecting strain, while Group B secondary cases received standard short-course therapy.

RESULTS: Among 945 close contacts, 72 secondary TB cases (8%) were found. Of 42 who had drug-susceptibility testing, 35 (84%) were MDR-TB, but only seven (17%) had the same drug susceptibility profile as the index case. Cure exceeded 80% in Group A secondary cases, while only half of Group B secondary cases were cured (RR 1.6, 95%CI 1.1–2.2).

CONCLUSION: Contact investigation protocols coupled with enrollment in MDR-TB therapy are a useful means of detecting and promptly treating persons with infectious MDR-TB. In settings with endemic MDR strains of Mycobacterium tuberculosis, effective therapy of contacts of MDR-TB patients requires knowledge of drug susceptibility for each contact with active disease.

Keywords: DOTS-Plus; Peru; case finding; contact investigations; multidrug-resistant tuberculosis

Document Type: Regular Paper

Affiliations: 1: Socios En Salud Sucursal Peru/Partners In Health, Lima, Peru; and the Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, USA 2: Dirección de Salud V Lima Ciudad, Programa de Control de Tuberculosis, Lima, Peru 3: Socios En Salud Sucursal Peru/Partners In Health, Lima, Peru 4: Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, USA

Publication date: December 1, 2003

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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