Willingness to take multidrug-resistant tuberculosis (MDR-TB) preventive therapy among adult and adolescent household contacts of MDR-TB index cases: an international multi-site cross-sectional study

Abstract

BACKGROUND:
Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (TPT) to decrease their risk of TB disease.

METHODS:
In this cross-sectional study of HHCs of MDR and rifampicin resistant (RR)-TB index cases from 16 clinical research sites in eight countries, enrollees were interviewed to assess willingness to take a hypothetical, newly-developed MDR TPT if offered. In order to identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering.

RESULTS:
From 278 MDR/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 years (IQR 22-49) and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling [adjusted Odds Ratio (aOR) 1.83, 95% confidence interval (95%CI) 1.07-3.13], appropriate TB-related knowledge (aOR 2.22, 95%CI 1.23-3.99), confidence in taking TPT (aOR 7.16, 95%CI 3.33-15.42), and being comfortable telling others about taking MDR TPT (aOR 2.29, 95%CI 1.29-4.06).

CONCLUSIONS:
The high percentage of HHCs of MDR/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.