Abstract
The Article by Peter Dodd and colleagues (July, 2022)1Dodd PJ Mafirakureva N Seddon JA McQuaid CF The global impact of household contact management for children on multidrug-resistant and rifampicin-resistant tuberculosis cases, deaths, and health-system costs in 2019: a modelling study.Lancet Glob Health. 2022; 10: e1034-e1044Google Scholar provides a rationale for why we should increase the global use of household contact management for people exposed to rifampicin-resistant tuberculosis. Despite widespread acceptance of what needs to be done, there is a lack of knowledge regarding how such work could be structured. In 2020, the humanitarian organisation Médecins Sans Frontiàres partnered with ten government clinics in Khayelitsha, South Africa, to launch an expanded post-exposure management programme—including tuberculosis preventive therapy—for people exposed to rifampicin-resistant tuberculosis as part of an emergency response to the COVID-19 pandemic. In 2020 and 2021, this programme provided care in 56 households of newly diagnosed people with rifampicin-resistant tuberculosis. Our programme is nurse-led and most of the activities occur in the household and community. After disclosure counselling for the newly diagnosed person with rifampicin-resistant tuberculosis, household members of all ages are assessed clinically for active disease. Children and adolescents who are well and younger than 18 years are started on tuberculosis preventive therapy, usually with levofloxacin, although if there is fluroquinolone resistance, other agents (eg, delamanid) are used. Individuals who need a more detailed assessment by a physician or chest radiography are referred to clinics (at convenient times for families) and provided with transportation support. Tuberculosis preventive therapy is administered by nurses and community health workers, and paediatric formulations are used for children younger than 5 years. The success of this programme shows that families and households can be reached for prevention and screening of rifampicin-resistant tuberculosis. We as clinicians have a responsibility to these vulnerable individuals to implement such efforts more widely and without delay. JF has received a grant from the Stop TB Partnership to support the roll out of child-friendly formulations of second-line medications. All other authors declare no competing interests. The global impact of household contact management for children on multidrug-resistant and rifampicin-resistant tuberculosis cases, deaths, and health-system costs in 2019: a modelling studyHCM for patients with multidrug-resistant or rifampicin-resistant tuberculosis is cost-effective in most settings and could avert a substantial proportion of multidrug-resistant or rifampicin-resistant tuberculosis cases and deaths in children globally. Full-Text PDF Open Access
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