Contact investigations as a means of detection and timely treatment of persons with infectious multidrug-resistant tuberculosis.
METHODS
Two regions of metropolitan Lima, Peru.


OBJECTIVE
To determine the outcomes of two contact investigation strategies used in therapy enrollment cohorts of patients with multidrug-resistant tuberculosis (MDR-TB).


METHODS
From 28 August 1996 to 31 December 1999, 91 index patients received individualized MDR-TB therapy (Group A), and from 1 October 1997 to 31 December 1999, another 101 index patients received a standardized MDR-TB regimen (Group B). We conducted a retrospective chart review and home visits to identify secondary cases among close contacts of both of these groups. Group A secondary cases with MDR-TB received therapy based on the drug susceptibility profile of their infecting strain, while Group B secondary cases received standard short-course therapy.


RESULTS
Among 945 close contacts, 72 secondary TB cases (8%) were found. Of 42 who had drug-susceptibility testing, 35 (84%) were MDR-TB, but only seven (17%) had the same drug susceptibility profile as the index case. Cure exceeded 80% in Group A secondary cases, while only half of Group B secondary cases were cured (RR 1.6, 95%CI 1.1-2.2).


CONCLUSIONS
Contact investigation protocols coupled with enrollment in MDR-TB therapy are a useful means of detecting and promptly treating persons with infectious MDR-TB. In settings with endemic MDR strains of Mycobacterium tuberculosis, effective therapy of contacts of MDR-TB patients requires knowledge of drug susceptibility for each contact with active disease.
Bayona
J
J
Socios En Salud Sucursal Peru/Partners In Health, Lima, Peru.
Chavez-Pachas
A M
AM
Palacios
E
E
Llaro
K
K
Sapag
R
R
Becerra
M C
MC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016358:Contact Tracing; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010568:Peru; D012189:Retrospective Studies; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000517:prevention & control* / Q000635:transmission