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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.

Authors
  • Suryavanshi, Nishi1
  • Murrill, Matthew2
  • Gupta, Amita1, 2
  • Hughes, Michael3
  • Hesseling, Anneke4
  • Kim, Soyeon3
  • Naini, Linda5
  • Jones, Lynne6
  • Smith, Betsy7
  • Gupte, Nikhil1, 2
  • Dawson, Rodney8
  • Mave, Vidya1, 2
  • Meshram, Sushant1
  • Mendoza-Ticona, Alberto9
  • Sanchez, Jorge10
  • Kumarasamy, Nagalingeswaran11
  • Comins, Kyla12
  • Conradie, Francesca13
  • Shenje, Justin14
  • Nerette Fontain, Sandy15
  • And 10 more
  • 1 Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India. , (India)
  • 2 Johns Hopkins Medical Institutions, Baltimore, Maryland.
  • 3 Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
  • 4 Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa. , (South Africa)
  • 5 Social and Scientific Systems, Inc, Silver Springs, Maryland.
  • 6 Frontier Science and Technology Research Foundation, Amherst, New York.
  • 7 National Institutes of Health, Bethesda, Maryland.
  • 8 University of Cape Town Lung Institute, Mowbray, South Africa. , (South Africa)
  • 9 Barranco Clinical Research Site.
  • 10 Asociación Civil Impacta Salud y Educación, San Miguel Clinical Research Site, Lima, Peru. , (Peru)
  • 11 Chennai Antiviral Research and Treatment Clinical Research Site, India. , (India)
  • 12 TASK Applied Science Clinical Research Site, Bellville.
  • 13 University of the Witwatersrand Helen Joseph Hospital, Johannesburg.
  • 14 South African Tuberculosis Vaccine Initiative, Cape Town, South Africa. , (South Africa)
  • 15 GHESKIO Centers-Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti. , (Haiti)
  • 16 Gaborone Clinical Research Site, Botswana. , (Botswana)
  • 17 Program for HIV Prevention and Treatment-Chiangrai Prachanukroh Hospital, Thailand. , (Thailand)
  • 18 Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg.
  • 19 Durban International Clinical Research Site, South Africa. , (South Africa)
  • 20 Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. , (Brazil)
  • 21 Kenya Medical Research Institute, Kisumu. , (Kenya)
  • 22 University of Nebraska Medical Center, Omaha.
  • 23 Aurum Institute.
  • 24 School of Public Health, University of the Witwatersrand, Johannesburg.
  • 25 Advancing Care and Treatment for TB/HIV, South African Medical Research Council, Parktown, South Africa. , (South Africa)
  • 26 Centers for Disease Control and Prevention, Atlanta, Georgia. , (Georgia)
Type
Published Article
Journal
Clinical Infectious Diseases
Publisher
Oxford University Press
Publication Date
Jan 16, 2020
Volume
70
Issue
3
Pages
436–445
Identifiers
DOI: 10.1093/cid/ciz254
PMID: 30919881
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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]). 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. © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected]

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