Uncovering Household Tuberculosis Infection Testing and Care Patterns Using a Novel Bioinformatics Linkage Strategy

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Tuberculosis Research

Background:

• Households are key for tuberculosis (TB) active case finding.
• Limited data exists on latent TB infection clustering within households without known infectious cases.
• Understanding household dynamics is crucial for TB infection care cascade progression.

Purpose of the Study:

• To investigate latent TB infection clustering in households.
• To analyze TB infection care cascade progression among household members.
• To identify predictors for testing, positivity, and treatment in household contacts.

Main Methods:

• Utilized data from a US community health center network (2014-2022).
• Identified sentinel patients with positive TB tests (TST or IGRA).
• Linked sentinel patients to household members and analyzed testing, positivity, and treatment rates.

Main Results:

• 35,772 sentinel patients linked to 129,432 household members.
• 26.1% of household members were tested; 9.3% tested positive.
• Treatment was prescribed to 20.6% of positive household members; sentinel patient treatment influenced outcomes.

Conclusions:

• A significant gap exists in documented TB infection testing for household members.
• Household and patient characteristics impact testing, positivity, and treatment.
• Households represent an underutilized setting for TB infection identification and treatment, even without active TB disease.