. 2023 Mar 17;18(3):e0283290.

doi: 10.1371/journal.pone.0283290. eCollection 2023.

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

Soyeon Kim¹, Anneke C Hesseling², Xingye Wu³, Michael D Hughes³, N Sarita Shah⁴, Sanjay Gaikwad⁵, Nishi Kumarasamy⁶, Erika Mitchell⁷, Mey Leon⁸, Pedro Gonzales⁹, Sharlaa Badal-Faesen¹⁰, Madeleine Lourens¹¹, Sandy Nerette¹², Justin Shenje¹³, Petra de Koker², Supalert Nedsuwan¹⁴, Lerato Mohapi¹⁵, Unoda A Chakalisa¹⁶, Rosie Mngqbisa¹⁷, Rodrigo Otávio da Silva Escada¹⁸, Samuel Ouma¹⁹, Barbara Heckman²⁰, Linda Naini²¹, Amita Gupta²², Susan Swindells²³, Gavin Churchyard²⁴; ACTG A5300/IMPAACT 2003 PHOENIx Feasibility Study Team

Affiliations

¹ Department of Biostatistics, Frontier Science Foundation, Brookline, Massachusetts, United States of America.
² Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa.
³ Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
⁴ Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
⁵ Byramjee Jeejeebhoy Government Medical College CRS and Sassoon General Hospital, BJMC Clinical Research Site, Pune, Maharashtra, India.
⁶ Chennai Antiviral Research and Treatment (CART), Infectious Disease Medical Center, Voluntary Health Services, Chennai, India.
⁷ Department of Medicine and University of Cape Town Lung Institute, Division of Pulmonology, University of Cape Town, Cape Town, South Africa.
⁸ Barranco CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru.
⁹ San Miguel CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru.
¹⁰ University of the Witwatersrand CRS, University of the Witwatersrand, Johannesburg, South Africa.
¹¹ TASK Applied Science CRS, Brooklyn Chest Hospital, Bellville, South Africa.
¹² Institute of Infectious Diseases and Reproductive Health, Les Centres GHESKIO, Port-au-Prince, Haiti.
¹³ South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa.
¹⁴ PHPT-Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.
¹⁵ Soweto CRS, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
¹⁶ Gaborone CRS, Princess Marina Hospital, Gaborone, Botswana.
¹⁷ Durban Adult HIV CRS, Enhancing Care Foundation, Durban University of Technology, Durban, South Africa.
¹⁸ Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Brazil.
¹⁹ Kenya Medical Research Institute, Kisumu, Kenya.
²⁰ Frontier Science Foundation, Amherst, New York, United States of America.
²¹ Department of Clinical Research and Bioscience, Social & Scientific Systems, Silver Spring, Maryland, United States of America.
²² Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
²³ Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America.
²⁴ Aurum Institute, Parktown, South Africa, School of Public Health, University of Witwatersrand, Johannesburg, South Africa, Vanderbilt University, Nashville, Tennessee, United States of America.

PMID: 36930628
PMCID: PMC10022776
DOI: 10.1371/journal.pone.0283290

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

Soyeon Kim et al. PLoS One. 2023.

. 2023 Mar 17;18(3):e0283290.

doi: 10.1371/journal.pone.0283290. eCollection 2023.

Authors

Affiliations

¹ Department of Biostatistics, Frontier Science Foundation, Brookline, Massachusetts, United States of America.
² Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa.
³ Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
⁴ Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
⁵ Byramjee Jeejeebhoy Government Medical College CRS and Sassoon General Hospital, BJMC Clinical Research Site, Pune, Maharashtra, India.
⁶ Chennai Antiviral Research and Treatment (CART), Infectious Disease Medical Center, Voluntary Health Services, Chennai, India.
⁷ Department of Medicine and University of Cape Town Lung Institute, Division of Pulmonology, University of Cape Town, Cape Town, South Africa.
⁸ Barranco CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru.
⁹ San Miguel CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru.
¹⁰ University of the Witwatersrand CRS, University of the Witwatersrand, Johannesburg, South Africa.
¹¹ TASK Applied Science CRS, Brooklyn Chest Hospital, Bellville, South Africa.
¹² Institute of Infectious Diseases and Reproductive Health, Les Centres GHESKIO, Port-au-Prince, Haiti.
¹³ South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa.
¹⁴ PHPT-Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.
¹⁵ Soweto CRS, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
¹⁶ Gaborone CRS, Princess Marina Hospital, Gaborone, Botswana.
¹⁷ Durban Adult HIV CRS, Enhancing Care Foundation, Durban University of Technology, Durban, South Africa.
¹⁸ Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Brazil.
¹⁹ Kenya Medical Research Institute, Kisumu, Kenya.
²⁰ Frontier Science Foundation, Amherst, New York, United States of America.
²¹ Department of Clinical Research and Bioscience, Social & Scientific Systems, Silver Spring, Maryland, United States of America.
²² Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
²³ Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America.
²⁴ Aurum Institute, Parktown, South Africa, School of Public Health, University of Witwatersrand, Johannesburg, South Africa, Vanderbilt University, Nashville, Tennessee, United States of America.

PMID: 36930628
PMCID: PMC10022776
DOI: 10.1371/journal.pone.0283290

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.

Copyright: © 2023 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Fig 1. Participant flow diagram.**
Abbreviations: HH, Household; HHC, household contact; IGRA, interferon-gamma release assay.

See this image and copyright information in PMC

References

1. World Health Organization, Global Tuberculosis Report 2020. 2020, World Health Organization.
1. Seung K.J., Keshavjee S., and Rich M.L., Multidrug-Resistant Tuberculosis and Extensively Drug-Resistant Tuberculosis. Cold Spring Harb Perspect Med, 2015. 5(9): p. a017863. - PMC - PubMed
1. World Health Organization, WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment: Module 1: prevention. 2020: Geneva. - PubMed
1. Kim S., et al.., High Prevalence of Tuberculosis Infection and Disease in Child Household Contacts of Adults With Rifampin-resistant Tuberculosis. Pediatr Infect Dis J, 2022. 41(5): p. e194–e202. - PMC - PubMed
1. Bates M.N., et al.., Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Arch Intern Med, 2007. 167(4): p. 335–42. - PubMed

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

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

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Conflict of interest statement

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