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

Nishi Suryavanshi, Matthew Murrill, Amita Gupta, Michael Hughes, Anneke Hesseling, Soyeon Kim, Linda Naini, Lynne Jones, Betsy Smith, Nikhil Gupte, Rodney Dawson, Vidya Mave, Sushant Meshram, Alberto Mendoza-Ticona, Jorge Sanchez, Nagalingeswaran Kumarasamy, Kyla Comins, Francesca Conradie, Justin Shenje, Sandy Nerette FontainAnthony Garcia-Prats, Aida Asmelash, Supalert Nedsuwan, Lerato Mohapi, Umesh Lalloo, Ana Cristina Garcia Ferreira, Elisha Okeyo, Susan Swindells, Gavin Churchyard, N. Sarita Shah

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)436-445
Number of pages10
JournalClinical Infectious Diseases
Volume70
Issue number3
DOIs
StatePublished - Feb 1 2020

Keywords

  • Contacts
  • Drug resistance
  • Preventive therapy
  • Prophylaxis
  • Tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Suryavanshi, N., Murrill, M., Gupta, A., Hughes, M., Hesseling, A., Kim, S., Naini, L., Jones, L., Smith, B., Gupte, N., Dawson, R., Mave, V., Meshram, S., Mendoza-Ticona, A., Sanchez, J., Kumarasamy, N., Comins, K., Conradie, F., Shenje, J., ... Shah, N. S. (2020). 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. Clinical Infectious Diseases, 70(3), 436-445. https://doi.org/10.1093/cid/ciz254