Title
A case-control study to identify community venues associated with genetically-clustered, multidrug-resistant tuberculosis disease in Lima, Peru
Date Issued
24 April 2019
Access level
open access
Resource Type
journal article
Author(s)
Publisher(s)
Oxford University Press
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.
Start page
1547
End page
1555
Volume
68
Issue
9
Language
English
OCDE Knowledge area
Genética humana
Sistema respiratorio
Subjects
Scopus EID
2-s2.0-85067849251
PubMed ID
Source
Clinical Infectious Diseases
ISSN of the container
10584838
Sources of information:
Directorio de Producción Científica
Scopus