A Case-Control Study to Identify Community Venues Associated with Genetically-clustered, Multidrug-resistant Tuberculosis Disease in Lima, Peru

• Published in: Clinical infectious diseases Vol. 68; no. 9; pp. 1547 - 1555
• Main Authors: Bui, David P, Oren, Eyal, Roe, Denise J, Brown, Heidi E, Harris, Robin B, Knight, Gwenan M, Gilman, Robert H, Grandjean, Louis
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 24.04.2019
• Subjects: and Commentaries; social network; tuberculosis; genotyping; multidrug-resistant; community transmission
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy746

Abstract Background The majority of tuberculosis transmission occurs in community settings. Our primary aim in this study was to assess the association between exposure to community venues and multidrug-resistant (MDR) tuberculosis. Our secondary aim was to describe the social networks of MDR tuberculosis cases and controls. Methods We recruited laboratory-confirmed MDR tuberculosis cases and community controls that were matched on age and sex. Whole-genome sequencing was used to identify genetically clustered cases. Venue tracing interviews (nonblinded) were conducted to enumerate community venues frequented by participants. Logistic regression was used to assess the association between MDR tuberculosis and person-time spent in community venues. A location-based social network was constructed, with respondents connected if they reported frequenting the same venue, and an exponential random graph model (ERGM) was fitted to model the network. Results We enrolled 59 cases and 65 controls. Participants reported 729 unique venues. The mean number of venues reported was similar in both groups (P = .92). Person-time in healthcare venues (adjusted odds ratio [aOR] = 1.67, P = .01), schools (aOR = 1.53, P < .01), and transportation venues (aOR = 1.25, P = .03) was associated with MDR tuberculosis. Healthcare venues, markets, cinemas, and transportation venues were commonly shared among clustered cases. The ERGM indicated significant community segregation between cases and controls. Case networks were more densely connected. Conclusions Exposure to healthcare venues, schools, and transportation venues was associated with MDR tuberculosis. Intervention across the segregated network of case venues may be necessary to effectively stem transmission. Multidrug-resistant tuberculosis (MDR-TB) transmission occurs in community venues. Identifying high-risk venues may direct community prevention efforts. We used whole-genome sequencing, venue-tracing interviews, and both conventional and social network analyses to identify several community venue types associated with MDR-TB.