Background

We assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial.

Methods

We conducted a cross-sectional study of adult MDR-TB cases and their HHCs in 8 countries with high TB burdens. HHCs underwent symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing.

Results

From October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were positive for acid-fast bacilli sputum smears and 43% had cavitary disease; at study entry, 35% remained smear positive after a median MDR-TB treatment duration of 8.8 weeks. There were 9 HHCs that were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. There were 121 (12%) HHCs that had new cases of TB identified: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) were aged <5 years; 63 (6%) were aged ≥5 and were infected with HIV; and 610 (61%) were aged ≥5 years, were negative for HIV or had an unknown HIV status, and were TBI positive. Only 21 (2%) HHCs were on preventive therapy.

Conclusions

The majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel, preventive therapies are urgently needed to inform treatment policy and practice.

中文翻译：

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确定高风险发展为结核病风险的利福平和耐多药结核病家庭住户接触的可行性

背景

我们评估了耐多药结核病（MDR-TB）病例和他们的家庭接触者（HHCs），以为介入性临床试验的发展提供信息。

方法

我们对8个结核病负担高的国家的成年耐多药结核病病例及其HHC进行了横断面研究。对HHC进行了症状筛查，胸部X线检查，痰TB细菌学检查，TB感染（TBI）测试（结核菌素皮肤测试[TST]和干扰素γ释放测定[IGRA]）以及人类免疫缺陷病毒（HIV）测试。

结果

从2015年10月到2016年4月，纳入了284例耐多药结核病病例的1016例HHC。确诊时，耐多药肺结核痰涂片阳性的耐多药结核病患者占69％，患有空洞疾病的患者占43％；在研究开始时，中位耐多药结核病治疗时间为8.8周后，仍有35％的涂片阳性。进入前有9例HHC被诊断为结核，并被排除在外。在其余的1007个HHC中，男性占41％，中位年龄为25岁。已鉴定出121例（12％）HHC，其中有新的结核病例：确诊的17例（2％），33例（3％）可能的结核病和71例（7％）的结核病病例。TBI患病率（定义为TST或IGRA阳性）为72％，并随年龄，使用的测试和国家/地区而异。在这些互斥组中，有1007个HHC中有775个（77％）被认为是高风险的：年龄小于5岁的有102个（10％）；63岁（6％）年龄≥5岁且感染了艾滋病毒；610岁（61％）的年龄≥5岁，HIV阴性或艾滋病毒状态未知以及TBI阳性。只有21（2％）的HHC处于预防性治疗。

结论

在这些高负担国家，大多数HHCs患结核病和感染的风险很高，但很少接受常规的预防性治疗。迫切需要尝试新颖的预防性疗法，以告知治疗政策和实践。