Willingness to Take Multidrug-resistant Tuberculosis (MDR-TB) Preventive Therapy Among Adult and Adolescent Household Contacts of MDR-TB Index Cases: An International Multisite Cross-sectional Study

Abstract

Background Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (MDR TPT) to decrease their risk of TB disease. Methods In this cross-sectional study of HHCs of MDR-TB and rifampicin-resistant tuberculosis (RR-TB) index cases from 16 clinical research sites in 8 countries, enrollees were interviewed to assess willingness to take a hypothetical, newly developed MDR TPT if offered. To identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering. Results From 278 MDR-TB/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 (interquartile range, 22–49) years, and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling (adjusted odds ratio [aOR], 1.83 [95% confidence interval {CI}, 1.07–3.13]), appropriate TB-related knowledge (aOR, 2.22 [95% CI, 1.23–3.99]), confidence in taking MDR TPT (aOR, 7.16 [95% CI, 3.33–15.42]), and being comfortable telling others about taking MDR TPT (aOR, 2.29 [95% CI, 1.29–4.06]). Conclusions The high percentage of HHCs of MDR-TB/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.

Multidrug-Resistant Tuberculosis Among Children Under 15 Years of Age in Khyber Pakhtunkhwa Province and Federally Administered Tribal Areas Pakistan

“…MDR-TB equally effects populattion of all age including children. Most of the studies were conducted on adults to find out risk factors causing MDR-TB and overlooked paediatric TB (14).…”

Caregiver willingness to give TPT to children living with drug-resistant TB patients

“…This study was conducted between October 2015 and April 2016 at 16 clinical research sites in eight countries: Botswana (1 site), Brazil (1), Haiti (1), India (2), Kenya (1), Peru (2), South Africa (7) and Thailand (1) in preparation for the PHOENIx trial being conducted by the AIDS Clinical Trials Group (ACTG; https://actgnetwork.org/ ) and International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT; http://impaactnetwork.org/ ). The study design has been discussed elsewhere 24 , 25 and is summarized briefly below.…”

“…As previously reported, all HHCs aged ≥13 years were requested to complete a KAP questionnaire regarding MDR-TB. 24 A subset of questions identified which HHCs were caring for children <13 years of age or a dependent of any age. The present analysis was restricted to HHCs who reported being responsible for a child <13 years of age or a dependent of any age.…”

Tuberculosis epidemic in India – a systematic review

“…16,22,29,55,63 Drug-resistant tuberculosis According to current trends, drug-resistant tuberculosis (DR-TB), which is resistant to a variety of anti-tuberculosis drugs, is a serious problem in the Indian population, and as a result, it has become a new impediment to India's efforts to combat the illness. 33,36,45,56,59,64,65 The four first-line antibiotics for tuberculosis are rifampicin, isoniazid, pyrazinamide, and ethambutol. They are typically used in conjunction with other TB medications for the first 6 to 9 months of a patient's treatment.…”

“…28,35 Furthermore, old age group healthcare professionals are at a higher risk of developing a particularly latent TB infection due to their longer duration of employment and working in areas with high TB prevalence. 5,35,36…”