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Volume 27, Number 3—March 2021
CME ACTIVITY - Research

Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan

Amyn A. MalikComments to Author , Neel R. Gandhi, Timothy L. Lash, Lisa M. Cranmer, Saad B. Omer, Junaid F. Ahmed, Sara Siddiqui, Farhana Amanullah, Aamir J. Khan, Salmaan Keshavjee, Hamidah Hussain1, and Mercedes C. Becerra1
Author affiliations: Emory University Rollins School of Public Health, Atlanta, Georgia, USA (A.A. Malik, N.R. Gandhi, T.L. Lash); Yale University, New Haven, Connecticut, USA (A.A. Malik, S.B. Omer); Global Health Directorate, Indus Health Network, Karachi, Pakistan (A.A. Malik, J.F. Ahmed, S. Siddiqui); Interactive Research and Development, Singapore (A.A. Malik, A.J. Khan, H. Hussain); Emory University School of Medicine, Atlanta (N.R. Gandhi, L.M. Cranmer); Emory + Children’s Pediatric Institute, Atlanta (L.M. Cranmer); The Indus Hospital, Karachi (F. Amanullah); Harvard University, Cambridge, Massachusetts, USA (A.J. Khan, S. Keshavjee, M.C. Becerra); Partners In Health, Boston, Massachusetts, USA (S. Keshavjee, M.C. Becerra); Brigham and Women’s Hospital, Boston (S. Keshavjee, M.C. Becerra)

Main Article

Table 2

Details of studies from which data were extracted for analysis in study of persons exposed at home to drug-resistant tuberculosis, Karachi, Pakistan, February 2016–March 2017*

Characteristic Becerra et al. (25) Fox et al. (22) Reichler et al. (26) Martin-Sanchez et al. (27) Sloot et al. (28) Saunders et al. (29)
Setting
 Peru
 Global
 US and Canada
 Spain
 Netherlands
 Peru
Year
 2013
 2013
 2019
 2019
 2014
 2017
HHC age group, y
<15 1,299 N/A 879 77 1,489 NA
>15
 3,411
 N/A
 3,611
 876
 7,757
 1,910
IR or risk
 IR and risk
 IR and risk
 IR and risk
 IR and risk
 Risk
 Risk
IR or risk by PT status
 No PT for DR TB exposure
 No
 Yes
 Yes
 Yes
 No
IR or risk by age and year of follow-up
 Yes
 Not by age but by year of follow-up
 No
 No cases in children
 No
 No
IR or risk by risk group
 No
 No
 Yes
 Yes
 No
 Yes
IR or risk reported
 <15 y, Y 1: 2,079/100,000 p-y; <15 y, Y 2: 315/100,000 p-y; >15 y, Y 1: 2,610/100,000 p-y; >15 y, Y 2: 1,309/100,000 p-y; risk: 163/4,515 (3.6%)
 Y 1: 1,478/100,000 p-y; Y 2: 831/100,000 p-y; risk: 898/65,935 (1.4%)
 Rate: 951/100,000 p-y; 5 y risk for TST-positive contacts without PT: 49/446 (11.0%)
 Rate: 1970/100,000 p-y; 5 y risk for TST-positive contacts not completing PT: 6/72 (8.3%)
 2 y risk in TST-positive contacts without PT: 9/372 (2.4%)
 2.5 y risk for medium- to high-risk contacts in validation cohort: 57/1,335 (4.3%)
Other limitations Some children received isoniazid-based PT NA P-y accumulated over 5 y No cases in children less than 15 y; p-y accumulated over 5.3 y Definition of incidence >6 mo HHCs >15 y

*DR TB, drug-resistant tuberculosis; HHC, household contacts; IR, incidence rate; PT, preventive therapy; p-y, person-years; TST, tuberculin skin test; Y, year of follow-up; NA, data not available.

Main Article

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Main Article

1These authors contributed equally to this article.

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Page updated: February 19, 2021
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