Multilevel Modeling of Household Contextual Determinants of Tuberculin Skin Test Positivity among Contacts of Infectious Tuberculosis Patients, Umerkot, Pakistan

Akhtar, Saeed; Rathi, Suresh Kumar

doi:10.4269/ajtmh.2009.80.351

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…*: p<0.05, statistically significant difference between contacts from high compared to low–middle-income countries. # : [25, 32, 36–50, 102–106, 110–127, 185–193]; ¶ : [33, 34, 103–105, 129, 135, 136, 140, 143, 144, 148–151, 153, 157, 163, 164, 172, 194–202]. Refer to the supplementary material for complete details of outcomes, estimates of heterogeneity and outcomes of individual included studies.…”

Section: Resultsmentioning

confidence: 99%

Contact investigation for tuberculosis: a systematic review and meta-analysis

et al. 2012

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Investigation of contacts of patients with tuberculosis (TB) is a priority for TB control in high-income countries, and is increasingly being considered in resource-limited settings. This review was commissioned for a World Health Organization Expert Panel to develop global contact investigation guidelines.We performed a systematic review and meta-analysis of all studies reporting the prevalence of TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB.After screening 9,555 titles, we included 203 published studies. In 95 studies from low- and middle-income settings, the prevalence of active TB in all contacts was 3.1% (95% CI 2.2–4.4%, I2=99.4%), microbiologically proven TB was 1.2% (95% CI 0.9–1.8%, I2=95.9%), and latent TB infection was 51.5% (95% CI 47.1–55.8%, I2=98.9%). The prevalence of TB among household contacts was 3.1% (95% CI 2.1–4.5%, I2=98.8%) and among contacts of patients with multidrug-resistant or extensively drug-resistant TB was 3.4% (95% CI 0.8–12.6%, I2=95.7%). Incidence was greatest in the first year after exposure. In 108 studies from high-income settings, the prevalence of TB among contacts was 1.4% (95% CI 1.1–1.8%, I2=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2–32.4%, I2=99.5%). There was substantial heterogeneity among published studies.Contacts of TB patients are a high-risk group for developing TB, particularly within the first year. Children <5 yrs of age and people living with HIV are particularly at risk. Policy recommendations must consider evidence of the cost-effectiveness of various contact tracing strategies, and also incorporate complementary strategies to enhance case finding.

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Section: Resultsmentioning

confidence: 99%

Contact investigation for tuberculosis: a systematic review and meta-analysis

et al. 2012

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“…TB risk in HHCs may vary by individual and household as well as by background community incidence, and investigating all HHCs in high-burden, low-resource countries may be inefficient or unfeasible. Estimates of risk should consider the correlation of risk factors of HHCs within a single household [ 9 ] to avoid overestimating effects when ignoring that correlation. To better inform TB programs on the precise burden of TB over time in HHCs, studies with sufficiently long follow-up and with comparable methods need to be conducted [ 1 , 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A prospective longitudinal study of tuberculosis among household contacts of smear-positive tuberculosis cases in Lima, Peru

et al. 2016

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BackgroundHousehold contacts (HHCs) of TB cases are at increased risk for TB disease compared to the general population but the risk may be modified by individual or household factors. We conducted a study to determine incident TB among HHCs over two years after exposure and to identify individual and household level risk factors.MethodsAdults newly diagnosed with a first episode of smear-positive pulmonary TB (index cases) between March 2010 and December 2011 in eastern Lima, were interviewed to identify their HHC and household characteristics. TB registers were reviewed for up to two years after the index case diagnosis and house visits were made to ascertain TB cases among HHC. The TB incidence rate ratio among HHCs as a function of risk factors was determined using generalized linear mixed models.ResultsThe 1178 index cases reported 5466 HHCs. In 402/1178 (34.1 %) households, at least one HHC had experienced a TB episode ever. The TB incidence among HHCs was 1918 (95%CI 1669–2194) per 100,000 person-years overall, and was 2392 (95%CI 2005–2833) and 1435 (95%CI 1139–1787) per 100,000 person-years in the first and second year, respectively. Incident TB occurred more than six months following the index case’s TB diagnosis in 121/205 (59.0 %) HHCs. In HHCs, bacillary load and time between symptoms and treatment initiation in the index case, as well as the relationship to the index case and the sex of the HHC all had a significant association with TB incidence in HHCs.ConclusionsIncidence of TB among HHCs was more than ten times higher than in the general population. Certain HHC and households were at higher risk of TB, we recommend studies to compare HHC investigation to households at highest risk versus current practice, in terms of efficiency.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1616-x) contains supplementary material, which is available to authorized users.

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“…4 – 6 Household contact investigations are considered as an important approach among other active-case finding strategies to increase TB case-detection rates and to interrupt the transmission of TB disease. 3 , 7 – 11 Household contacts are at high risk of Mtb infections 12 – 15 and developing active TB. 16 – 19 …”

Section: Introductionmentioning

confidence: 99%

Tuberculosis case finding in first-degree relative contacts not living with index tuberculosis cases in Kampala, Uganda

Chheng

Nsereko

Malone

et al. 2015

CLEP

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PurposeTo assess the prevalence of pulmonary tuberculosis among first-degree relative (FDR) contacts not living with tuberculosis (TB) cases.MethodsA cross-sectional analysis of household contacts living with an index TB case and FDR contacts living outside of households in Kampala, Uganda, is presented.ResultsA total of 177 contacts (52 FDRs and 125 index household contacts) of 31 TB cases were examined. Compared with index household contacts, FDR contacts were older, more likely to be TB symptomatic (50% vs 33%), had a higher percentage of abnormal chest X-rays (19% vs 11%), sputum smear positive (15% vs 5%), and many similar epidemiologic risk factors, including HIV infection (13% vs 10%). Contact groups had similar pulmonary tuberculosis prevalence: 9.6% in FDR vs 10.4% in index household contacts and similar Mycobacterium tuberculosis infection: 62% in FDR vs 61% in index households.ConclusionTB is common among FDR contacts. High TB prevalence justifies targeting FDRs during household contact investigations. Combining TB active-case finding among FDR contacts with household contact investigation in low-income setting is feasible. This should be part of national TB control program strategies for increasing TB case-detection rates and reducing community TB transmission and death.

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Multilevel Modeling of Household Contextual Determinants of Tuberculin Skin Test Positivity among Contacts of Infectious Tuberculosis Patients, Umerkot, Pakistan

Cited by 8 publications

References 37 publications

Contact investigation for tuberculosis: a systematic review and meta-analysis

Contact investigation for tuberculosis: a systematic review and meta-analysis

A prospective longitudinal study of tuberculosis among household contacts of smear-positive tuberculosis cases in Lima, Peru

Tuberculosis case finding in first-degree relative contacts not living with index tuberculosis cases in Kampala, Uganda

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