title: Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients.
abstract: OBJECTIVE
  To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group.
  
  
  METHODS
  We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV-positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months.
  
  
  RESULTS
  We recruited 148 spouses of smear-positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear-positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15-5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV-positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV-positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV-positive community controls. Of 54 HIV-positive spouses, 18 completed 6-month IPT. At 2 year follow-up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34-3.29).
  
  
  CONCLUSIONS
  Spouses are a high-risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short-duration therapy.
authors: Karonga Prevention Study, Malawi. matthew.chico@lshtm.ac.uk
authors: A
authors: A
authors: Crampin
authors: S
authors: S
authors: Kasimba
authors: N J
authors: NJ
authors: Mwaungulu
authors: R
authors: R
authors: Dacombe
authors: S
authors: S
authors: Floyd
authors: J R
authors: JR
authors: Glynn
authors: P E M
authors: PE
authors: Fine
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D018454:Spouses / Q000706:statistics & numerical data*; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid