Resource utilization for multidrug-resistant tuberculosis household contact investigations (A5300/I2003)
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.
Document Type: Research Article
Affiliations: 1: University of Nebraska Medical Center, Omaha, Nebraska 2: Johns Hopkins University School of Medicine, Baltimore, Maryland 3: Frontier Science Foundation, Brookline, Massachusetts 4: Harvard T H Chan School of Public Health, Boston, Massachusetts, USA 5: Asociación Civil Impacta Salud y Educación, Lima, Peru 6: Byramjee Jeejeebhoy Government Medical College Clinical Research Site, Pune, India 7: University of Cape Town Lung Institute, Cape Town, South Africa 8: 9: Task Applied Science CRS, Bellville, South Africa 10: National Institutes of Health, Bethesda, MD, USA 11: Social & Scientific Systems, Inc, Silver Springs, Maryland 12: Centers for Disease Control and Prevention, Atlanta, Georgia, USA 13: Desmond Tutu TB Centre, Stellenbosch University, Tygerberg 14: The Aurum Institute, Johannesburg, School of Public Health, University of Witwatersrand, Johannesburg, Advancing Care and Treatment for TB and HIV, South African Medical Research Council, Johannesburg, South Africa
Publication date: 01 September 2018
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