Factors associated with prevalent Mycobacterium tuberculosis infection and disease among adolescents and adults exposed to rifampin-resistant tuberculosis in the household

• Type of Material: Article
• Authors: Sarita Shah, Emory University; Soyeon Kim, Frontier Science & Technology Research Foundation, Inc.; Anneke C Hesseling, Stellenbosch University; Xingye Wu, Harvard T.H. Chan School of Public Health; Michael D Hughes, Harvard T.H. Chan School of Public Health; N Sarita Shah, Emory University; Sanjay Gaikwad, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals; Nishi Kumarasamy, The Voluntary Health Services, Chennai; Erika Mitchell, University of Cape Town Lung Institute; Mey Leon, Asociación Civil Impacta Salud y Educación; Pedro Gonzales, Asociación Civil Impacta Salud y Educación; Sharlaa Badal-Faesen, University of the Witwatersrand, Johannesburg; Madeleine Lourens, TASK Applied Science; Sandy Nerette, Groupe d’étude Haïtien sur le Sarcome de Kaposi et les Infections Opportunistes; Justin Shenje, South African Tuberculosis Vaccine Initiative; Petra de Koker, Stellenbosch University, Faculty of Medicine and Health Sciences; Supalert Nedsuwan, Chiangrai Prachanukroh Hospital; Lerato Mohapi, University of the Witwatersrand, Johannesburg; Unoda A Chakalisa, Princess Marina Hospital; Rosie Mngqbisa, Durban University of Technology; Rodrigo Otávio da Silva Escada, Instituto Nacional de Infectologia Evandro Chagas (INI); Samuel Ouma, Kenya Medical Research Institute; Barbara Heckman, Frontier Science & Technology Research Foundation, Inc.; Linda Naini, Social & Scientific Systems, Inc.; Amita Gupta, Johns Hopkins University; Susan Swindells, University of Nebraska Medical Center; Gavin Churchyard, Aurum Institute, Parktown, South Africa
• Language: English
• Date: 2023-03-01
• Publisher: Emory University Libraries
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Kim et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0283290
• Title of Journal or Parent Work: PLoS ONE
• Volume: 18
• Issue: 3 March
• Start Page: e0283290
• End Page: e0283290
• Grant/Funding Information: Research reported in this publication was supported by the AIDS Clinical Trials Group (ACTG) and the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT). Support for the ACTG was provided by National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) under Award Number UM1AI068634 (ACTG SDMC) (SK, XW, MDH), UM1AI068636 (ACTG LOC) (SK, XW, MDH) and UM1AI106701 (ACTG LC). Support for IMPAACT was provided by NIAID with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Mental Health (NIMH), all components of the NIH, under Award Numbers UM1AI068616 (IMPAACT SDMC) (SK), UM1AI068632 (IMPAACT LOC) (SK), and UM1AI106716 (IMPAACT LC), and by NICHD contract number HHSN275201800001I. Representatives of the NIH served as members of the study team and played a role in the study design of the main study, reviewed data for study conduct, but did not play a role in the decision to publish or prepare this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
• Keywords: Adolescent; Drug Resistance, Bacterial; Tuberculin Test; Cross-Sectional Studies; Tuberculosis; Adult; Rifampin; Male; Risk Factors; Mycobacterium tuberculosis; Female; Humans; Tuberculosis, Pulmonary
• Research Categories: Biology, Biostatistics; Health Sciences, Public Health

Abstract

Background Understanding factors associated with prevalent Mycobacterium tuberculosis infection and prevalent TB disease in household contacts of patients with drug-resistant tuberculosis (TB) may be useful for TB program staff conducting contact investigations. Methods Using data from a cross-sectional study that enrolled index participants with rifampin-resistant pulmonary TB and their household contacts (HHCs), we evaluated HHCs age ≥15 years for factors associated with two outcomes: Mycobacterium tuberculosis infection and TB disease. Among HHCs who were not already diagnosed with current active TB disease by the TB program, Mycobacterium tuberculosis infection was determined by interferon-gamma release assay (IGRA). TB disease was adjudicated centrally. We fitted logistic regression models using generalized estimating equations. Results Seven hundred twelve HHCs age ≥15 years enrolled from 279 households in eight high-TB burden countries were a median age of 34 years, 63% female, 22% current smokers and 8% previous smokers, 8% HIV-positive, and 11% previously treated for TB. Of 686 with determinate IGRA results, 471 tested IGRA positive (prevalence 68.8% (95% Confidence Interval: 64.6%, 72.8%)). Multivariable modeling showed IGRA positivity was more common in HHCs aged 25-49 years; reporting prior TB treatment; reporting incarceration, substance use, and/or a period of daily alcohol use in the past 12 months; sharing a sleeping room or more evenings spent with the index participant; living with smokers; or living in a home of materials typical of low socioeconomic status. Forty-six (6.5% (95% Confidence Interval: 4.6%, 9.0%)) HHCs age ≥15 years had prevalent TB disease. Multivariable modeling showed higher prevalence of TB disease among HHCs aged ≥50 years; reporting current or previous smoking; reporting a period of daily alcohol use in the past 12 months; and reporting prior TB treatment. Conclusion We identified overlapping and distinct characteristics associated with Mycobacterium tuberculosis infection and TB disease that may be useful for those conducting household TB investigations.