Shah Daksha, Bhide Sampada, Deshmukh Rajesh, Smith Jonathan P, Kaiplyawar Satish, Puri Varsha, Yeldandi Vijay, Date Anand, Nyendak Melissa, Ho Christine S, Moonan Patrick K
Brihanmumbai Municipal Corporation, Mumbai, India.
TB Department, Society for Health Allied Research and Education (SHARE) India, Hyderabad, India.
Front Tuberc. 2024;2. doi: 10.3389/ftubr.2024.1454277.
Mumbai is one of the most densely populated areas in the world and is a major contributor to the tuberculosis (TB) epidemic in India. A test and treat approach for TB infection (TBI) amongst household contacts (HHC) is part of the national policy for TB preventive treatment (TPT). However, in practice, the use of interferon-gamma release assay (IGRA) tests for infection are limited, and prevalence of TBI in Mumbai is not known.
We conducted a cross-sectional study among HHCs exposed to persons with microbiologically-confirmed, drug-susceptible pulmonary TB that were notified for antituberculosis treatment in Mumbai, India during September-December, 2021. Community-based field workers made home visits and offered IGRA (QuantiFERON-TB Gold In-Tube Plus) tests to HHC aged 5 years and older. After ruling out active TB disease, HHC with IGRA-positive test results were referred for TPT. All HHC were monitored for at least 24 months for progression to active TB disease.
Among 502 HHCs tested, 273 (54%) had IGRA-positive results. A total of 254 (93%) were classified as TBI and were eligible for TPT, of which 215 (85%) initiated TPT, and 194 (90%) completed TPT successfully. There was substantial variation in rates of TBI per household. In 32% of households, all HHC (100%) were IGRA positive and in 64% of households >50% of HHC were infected. In all, 22 HHCs (4%; 22/558) were diagnosed with TB disease; of these, five HHC were diagnosed during follow up, of which three were IGRA positive and had no evidence of disease at initial screening but chose not to initiate TPT.
A test and treat strategy for HHC resulted in the detection of a substantial proportion of TBI and secondary TB cases. Home-based IGRA testing led to high participation rates, clinical evaluations, TPT initiation, and early diagnoses of additional secondary cases. A community-focused, test and treat approach was feasible in this population and could be considered for broader implementation.
孟买是世界上人口最密集的地区之一，也是印度结核病流行的主要促成因素。对家庭接触者（HHC）中的结核感染（TBI）采用检测和治疗方法是国家结核病预防性治疗（TPT）政策的一部分。然而，在实际操作中，用于感染检测的干扰素-γ释放试验（IGRA）检测的使用有限，孟买TBI的患病率尚不清楚。
我们对2021年9月至12月期间在印度孟买因抗结核治疗而被通报的、接触过微生物学确诊的药物敏感型肺结核患者的HHC进行了一项横断面研究。社区现场工作人员进行家访，并为5岁及以上的HHC提供IGRA（管内QuantiFERON-TB Gold Plus）检测。在排除活动性结核病后，IGRA检测结果呈阳性的HHC被转诊接受TPT。对所有HHC进行至少24个月的监测，以观察是否进展为活动性结核病。
在502名接受检测的HHC中，273名（54%）IGRA检测结果呈阳性。共有254名（93%）被归类为TBI，有资格接受TPT，其中215名（85%）开始接受TPT，194名（90%）成功完成TPT。每户家庭的TBI发生率存在很大差异。在32%的家庭中，所有HHC（100%）IGRA检测呈阳性，在64%的家庭中，超过50%的HHC受到感染。共有22名HHC（4%；22/558）被诊断患有结核病；其中，5名HHC在随访期间被诊断出患有结核病，其中3名IGRA检测呈阳性，在初次筛查时没有疾病证据，但选择不开始接受TPT。
针对HHC的检测和治疗策略导致发现了相当比例的TBI和继发性结核病例。基于家庭的IGRA检测导致了高参与率、临床评估、TPT启动以及对其他继发性病例的早期诊断。以社区为重点的检测和治疗方法在该人群中是可行的，可以考虑更广泛地实施。
