HIV Testing Uptake Among the Household Contacts of Multidrug-resistant Tuberculosis Index Cases in Eight Countries

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International Journal of Tuberculosis and Lung Disease

The household contacts (HHCs) of multidrug-resistant tuberculosis (MDR-TB) index cases are at high risk of tuberculous infection and disease progression, particularly if infected with the human immunodeficiency virus (HIV). HIV testing is important for risk assessment and clinical management.

This was a cross-sectional, multi-country study of adult MDR-TB index cases and HHCs. All adult and child HHCs were offered HIV testing if never tested or if HIV-negative >1 year previously when last tested. We measured HIV testing uptake and used logistic regression to evaluate predictors.

A total of 1007 HHCs of 284 index cases were enrolled in eight countries. HIV status was known at enrolment for 226 (22%) HHCs; 39 (4%) were HIV-positive. HIV testing was offered to 769 (98%) of the 781 remaining HHCs; 544 (71%) agreed to testing. Of 535 who were actually tested, 26 (5%) were HIV-infected. HIV testing uptake varied by site (median 86%, range 0-100%; P < 0.0001), and was lower in children aged <18 years than in adults (59% vs. 78%; adjusted for site P < 0.0001).

HIV testing of HHCs of MDR-TB index cases is feasible and high-yield, with 5% testing positive. Reasons for low test uptake among children and at specific sites—including sites with high HIV prevalence—require further study to ensure all persons at risk for HIV are aware of their status.

Opollo VS, Wu X, Hughes MD, Swindells S, Gupta A, Hesseling A, Churchyard G, Kim S, Lando R, Dawson R, Mave V, Mendoza A, Gonzales P, Kumarasamy N, von Groote-Bidlingmaier F, Conradie F, Shenje J, Fontain SN, Garcia-Prats A, Asmelash A, Nedsuwan S, Mohapi L, Mngqibisa R, Garcia Ferreira AC, Okeyo E, Naini L, Jones L, Smith B, Shah NS. HIV testing uptake among the household contacts of multidrug-resistant tuberculosis index cases in eight countries. Int J Tuberc Lung Dis. 2018 Dec 1;22(12):1443-1449. doi: 10.5588/ijtld.18.0108.
  • Kenya Medical Research Institute, Kisumu, Kenya.
  • Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
  • University of Nebraska Medical Center, Omaha, Nebraska.
  • Desmond Tutu TB Centre, Stellenbosch University, Tygerberg.
  • The Aurum Institute, Johannesburg, South Africa.
  • Harvard T. H. Chan School of Public Health, Boston, Massachusetts, Frontier Science & Technology Research Foundation, Amherst, New York, USA.
  • University of Cape Town Lung Institute, Mowbray, South Africa.
  • Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India.
  • Asociacion Civil Impacta Salud y Educacion, Barranco Clinical Research Site, Lima.
  • Asociación Civil Impacta Salud y Educación, San Miguel Clinical Research Site (CRS), Lima, Peru.
  • Chennai Antiviral Research and Treatment CRS, Chennai, India.
  • TASK Applied Science CRS, Bellville.
  • University of the Witwatersrand, Helen Joseph Hospital, Johannesburg.
  • South African Tuberculosis Vaccine Initiative, Cape Town, South Africa.
  • GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) Centers Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti.
  • Gaborone CRS, Gaborone, Botswana.
  • Prevention and Treatment of HIV infection, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand.
  • Soweto CRS, Johannesburg.
  • Durban International CRS, Durban, South Africa.
  • Instituto Nacional de Infectologia/Fundação Oswaldo Cruz, Brazil.
  • Social & Scientific Systems, Inc, Silver Springs, Maryland.
  • Frontier Science & Technology Research Foundation, Amherst, New York, USA.
  • National Institutes of Health, Bethesda, Maryland.
  • Centers for Disease Control and Prevention, Atlanta, Georgia, USA.