Test and treat approach for tuberculosis infection amongst household contacts of drug-susceptible pulmonary tuberculosis, Mumbai, India

Details

• Alternative Title:
  Front Tuberc
• Personal Author:
  Shah, Daksha ; Bhide, Sampada ; Deshmukh, Rajesh ; Smith, Jonathan P. ; Kaiplyawar, Satish ; Puri, Varsha ; Yeldandi, Vijay ; Date, Anand ; Nyendak, Melissa ; Ho, Christine S. ; Moonan, Patrick K.
• Description:
  Background:
  
  Mumbai is one of the most densely populated areas in the world and is a major contributor to the tuberculosis (TB) epidemic in India. A test and treat approach for TB infection (TBI) amongst household contacts (HHC) is part of the national policy for TB preventive treatment (TPT). However, in practice, the use of interferon-gamma release assay (IGRA) tests for infection are limited, and prevalence of TBI in Mumbai is not known.
  
  Methods:
  
  We conducted a cross-sectional study among HHCs exposed to persons with microbiologically-confirmed, drug-susceptible pulmonary TB that were notified for antituberculosis treatment in Mumbai, India during September–December, 2021. Community-based field workers made home visits and offered IGRA (QuantiFERON-TB® Gold In-Tube Plus) tests to HHC aged 5 years and older. After ruling out active TB disease, HHC with IGRA-positive test results were referred for TPT. All HHC were monitored for at least 24 months for progression to active TB disease.
  
  Results:
  
  Among 502 HHCs tested, 273 (54%) had IGRA-positive results. A total of 254 (93%) were classified as TBI and were eligible for TPT, of which 215 (85%) initiated TPT, and 194 (90%) completed TPT successfully. There was substantial variation in rates of TBI per household. In 32% of households, all HHC (100%) were IGRA positive and in 64% of households >50% of HHC were infected. In all, 22 HHCs (4%; 22/558) were diagnosed with TB disease; of these, five HHC were diagnosed during follow up, of which three were IGRA positive and had no evidence of disease at initial screening but chose not to initiate TPT.
  
  Conclusion:
  
  A test and treat strategy for HHC resulted in the detection of a substantial proportion of TBI and secondary TB cases. Home-based IGRA testing led to high participation rates, clinical evaluations, TPT initiation, and early diagnoses of additional secondary cases. A community-focused, test and treat approach was feasible in this population and could be considered for broader implementation.
  
  
• Keywords:
  Contact Tracing Interferon-gamma Release Assay Latent TB Infection Tuberculosis
• Source:
  Front Tuberc. 2
• Pubmed ID:
  39421397
• Pubmed Central ID:
  PMC11485165
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:4840fe5243ed88c819a8c86034a094f24bb28d941d8ee62983a1396e58380f5e153d4297c734e9a3297f14df218fe08fa5eba5fbfd687879d4fdc6b017bbd725
• Download URL:
  https://stacks.cdc.gov/view/cdc/166678/cdc_166678_DS1.pdf
• File Type:
  [PDF - 1.22 MB ]