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

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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.
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Keywords: HHC investigation; MDR-TB; resource utilization

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: Chennai Antiviral Research and Treatment CRS, Chennai, India 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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  • 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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