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Hussain H, Jaswal M, Farooq S, Safdar N, Madhani F, Noorani S, Shahbaz SS, Salahuddin N, Amanullah F, Khowaja S, Manzar S, Shah JA, Islam Z, Dahri AA, Shahzad M, Keshavjee S, Becerra MC, Khan AJ, Malik AA. Scale-Up of Rifapentine and Isoniazid for Tuberculosis Prevention Among Household Contacts in 2 Urban Centers: An Effectiveness Assessment. Clin Infect Dis 2023; 77:638-644. [PMID: 37083926 DOI: 10.1093/cid/ciad245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Scaling up a shorter preventive regimen such as weekly isoniazid and rifapentine (3HP) for 3 months is a priority for tuberculosis (TB) preventive treatment (TPT). However, there are limited data on 3HP acceptability and completion from high-burden-TB countries. METHODS We scaled up 3HP from 2018 to 2021 in 2 cities in Pakistan. Eligible participants were household contacts of persons diagnosed with TB disease. Participants were prescribed 3HP after ruling out TB disease. Treatment was self-administered. We analyzed the proportion who completed 3HP. RESULTS In Karachi, we verbally screened 22 054 household contacts of all ages. Of these, 83% were clinically evaluated and 3% were diagnosed with TB. Of household contacts without TB disease, 59% initiated the 3HP regimen, of which 69% completed treatment. In Peshawar, we verbally screened 6389 household contacts of all ages. We evaluated 95% of household contacts, of whom 2% were diagnosed with TB disease. Among those without TB disease, 65% initiated 3HP, of which 93% completed. Factors associated with higher 3HP completion included residence in Peshawar (risk ratio [RR], 1.35 [95% confidence interval {CI}: 1.32-1.37]), index patient being a male (RR, 1.03 [95% CI: 1.01-1.05]), and index patient with extrapulmonary TB compared to bacteriologically positive pulmonary TB (RR, 1.10 [95% CI: 1.06-1.14]). The age of the index patient was inversely associated with completion. CONCLUSIONS We observed a high level of acceptance and completion of 3HP in programs implemented in 2 cities in Pakistan, with differences observed across the cities. These findings suggest that 3HP can be effectively scaled up in urban settings to improve the reach and impact of TPT.
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Affiliation(s)
| | - Maria Jaswal
- Interactive Research and Development (IRD) Pakistan, Karachi, Pakistan
| | - Saira Farooq
- Tuberculosis Program, The Indus Hospital and Health Network, Karachi, Pakistan
| | - Nauman Safdar
- Interactive Research and Development Global, Singapore
| | - Falak Madhani
- Programs Unit, Aga Khan Health Services Pakistan, Karachi, Pakistan
| | - Shehla Noorani
- Monitoring and Evaluation, UK Health Security Agency, London, United Kingdom
| | | | - Naseem Salahuddin
- Tuberculosis Program, The Indus Hospital and Health Network, Karachi, Pakistan
| | - Farhana Amanullah
- Tuberculosis Program, The Indus Hospital and Health Network, Karachi, Pakistan
| | - Saira Khowaja
- Interactive Research and Development Global, Singapore
| | - Shadab Manzar
- Tuberculosis Program, The Indus Hospital and Health Network, Karachi, Pakistan
| | - Jinsar Ali Shah
- Tuberculosis Program, The Indus Hospital and Health Network, Karachi, Pakistan
| | - Zafar Islam
- Tuberculosis Center District Headquarter Hospital Nowshera, Nowshera, Khyber Pakhtunkhwa, Pakistan
| | | | - Muddasser Shahzad
- Provincial Tuberculosis Control Program, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
| | - Aamir J Khan
- Interactive Research and Development Global, Singapore
| | - Amyn A Malik
- Interactive Research and Development Global, Singapore
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Preventive Therapy for Contacts of Drug-Resistant Tuberculosis. Pathogens 2022; 11:pathogens11101189. [PMID: 36297246 PMCID: PMC9609446 DOI: 10.3390/pathogens11101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
Preventing the progression of a drug-resistant tuberculosis (DR-TB) infection to disease is an important pillar of the DR-TB elimination strategy. International guidelines have recently proposed fluoroquinolones for tuberculosis preventive therapy (TPT) in DR-TB contacts, although the available evidence is low quality. The pooled data from small observational studies suggest that a fluoroquinolone-based TPT is safe, effective and cost-effective as a preventive treatment in DR-TB contacts. Three clinical trials are currently ongoing to generate higher quality evidence on the efficacy of levofloxacin and delamanid as a DR-TB preventive therapy. Additional evidence is also needed, regarding TPT treatment in fluoroquinolone-resistant-TB contacts, patient and health care worker perceptions on DR-TB preventive therapy for contacts, and the service delivery models to increase DR-TPT access. This state-of-the-art review presents the current literature on TPT for contacts of DR-TB cases, focusing on the available evidence and international guidelines.
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Malik AA, Becerra MC, Hussain H. Ringing the alarm bell: Time to scale up drug-resistant tuberculosis preventive treatment. EClinicalMedicine 2021; 34:100821. [PMID: 33855286 PMCID: PMC8027541 DOI: 10.1016/j.eclinm.2021.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Amyn A. Malik
- Yale Institute for Global Health, 1 Church Street, Suite 340, New Haven, CT 06510, USA
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
- Corresponding author at: Yale Institute for Global Health, 1 Church Street, Suite 340, New Haven, CT 06510, USA.
| | | | - Hamidah Hussain
- Interactive Research and Development (IRD) Global, Singapore
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