Social contact patterns of persons with pre-extensively drug-resistant tuberculosis and extensively drug-resistant tuberculosis in KwaZulu-Natal, South Africa Restricted; Files Only
Nerhood, Kayleigh (Spring 2023)
Abstract
Background: South Africa has among the highest burdens of drug-resistant tuberculosis (DR-TB) worldwide, with transmission driving its continued spread. Given the limited identified transmission events occurring in households, further investigation is needed to understand where and how transmission is occurring. We describe the social contact patterns of people with pre-extensively/extensively DR-TB (pre-XDR/XDR-TB) from an ongoing cross-sectional study in KwaZulu-Natal, South Africa.
Methods: We interviewed participants to capture data on their demographics, living conditions and urbanicity of their primary residence, places they lived and frequently visited in the 2 years before their interview, and close contacts at those locations. Close contacts included persons whom the participant “touched, talked to, or spent time near.” Contacts were stratified by their location(s) of contact: residential and/or community. We compared total named, residential, and community contacts across characteristics of the participants using negative binomial regression. Contact matrices were used to summarize preferential mixing of participants and contacts and assortative missing was quantified by calculating Q indices.
Results: From February 2019 to June 2022, 229 participants with complete interview data and at least one reported contact were included in the analytic study population. The median age was 36 (IQR: 30-44), 44% were female, and 74.4% were living with HIV. 2,463 total contacts were reported, including 1,570 community contacts and 1,173 residential contacts. Older age of participants was associated with decreased total and community contacts, increased household sizes were associated with increased total and residential contacts, current or recent employment was associated with increased residential contacts, and rural primary residence was associated with decreased community contacts. Participants preferentially mixed with people of similar ages and the same sex, especially in community locations while household mixing was typically intergenerational and less sex-specific.
Conclusions: High numbers of reported close contacts in the community indicate that control efforts may need to shift to capture this larger group. High contact rates among younger populations, especially in the community, also indicate the need to target interventions to this highly mobile population who may further spread TB to other generations in the home.
Table of Contents
CHAPTER I: LITERATURE REVIEW 1
Background & Epidemiology of Tuberculosis 1
Drug-Resistant Tuberculosis 3
Etiology of Drug-Resistant Tuberculosis 5
TB in South Africa 6
DR-TB in South Africa 8
Key and Vulnerable Populations of TB 8
Transmission of TB 11
Impact of the COVID-19 Pandemic 12
Contact Patterns of TB Cases 14
Methods to Describe Social Contact Patterns 15
Factors Impacting Social Contact Patterns 17
Impact of COVID-19 21
Future Directions 21
Conclusion 22
CHAPTER II: MANUSCRIPT 23
Introduction 23
Methods 25
Results 29
Discussion. 32
CHAPTER III: PUBLIC HEALTH IMPLICATIONS. 37
TABLES AND FIGURES. 39
SUPPLEMENTAL TABLES & FIGURES. 49
REFERENCES 53
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File download under embargo until 18 May 2025 | 2023-04-12 11:38:56 -0400 | File download under embargo until 18 May 2025 |
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