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

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Current guidelines advocate for evaluating household contacts (HHCs) of multidrug-resistant tuberculosis (MDR-TB) patients.
• Implementing this policy presents significant operational challenges.

Purpose of the Study:

• To assess resource utilization and operational difficulties in identifying and characterizing adult MDR-TB index cases and their HHCs.
• To determine the yield of HHC investigations in detecting new TB cases.

Main Methods:

• A cross-sectional study involving adult MDR-TB index cases and their HHCs across 16 sites in eight countries.
• Site-level resource utilization was assessed via surveys.
• Data collected included patient characteristics, diagnostic results, and operational challenges.

Main Results:

• 308 index cases and 1018 HHCs were enrolled; 34% of index cases were smear-positive, and 43% had cavitary disease.
• Evaluating 308 households required 512 attempts, with a median time of 4 hours per attempt.
• 77% of HHCs were at increased risk for TB, and 121 previously undiagnosed TB cases were identified.
• Operational challenges included personnel transportation, infection control, safety, and stigma management.

Conclusions:

• Household contact investigations for MDR-TB are high-yield, identifying numerous new cases.
• These investigations are labor-intensive and present significant operational challenges that need addressing for effective implementation.