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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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