Abstract
Tuberculosis (TB) elimination requires interrupting transmission of Mycobacterium tuberculosis. We used a multidisciplinary approach to describe TB transmission in 2 sociodemographically distinct districts in Botswana (Kopanyo Study). During August 2012–March 2016, all patients who had TB were enrolled, their sputum samples were cultured, and M. tuberculosis isolates were genotyped by using 24-locus mycobacterial interspersed repetitive units–variable number of tandem repeats. Of 5,515 TB patients, 4,331 (79%) were enrolled. Annualized TB incidence varied by geography (range 66–1,140 TB patients/100,000 persons). A total of 1,796 patient isolates had valid genotyping results and residential geocoordinates; 780 (41%) patients were involved in a localized TB transmission event. Residence in areas with a high burden of TB, age <24 years, being a current smoker, and unemployment were factors associated with localized transmission events. Patients with known HIV-positive status had lower odds of being involved in localized transmission.
Highlights
Tuberculosis (TB) elimination requires interrupting transmission of Mycobacterium tuberculosis
Multivariable logistic regression analysis was conducted to assess the association of involvement in a localized transmission event and select variables by using adjusted odds ratios that were significant at the 95% CIs
Our study helps clarify factors fueling the TB epidemic in Botswana and highlights the necessity of understanding local epidemiology to design effective interventions aimed at interrupting TB transmission
Summary
Tuberculosis (TB) elimination requires interrupting transmission of Mycobacterium tuberculosis. Progress toward elimination remains slow [3], in part because of the lack of effective interventions to interrupt the cycle of TB transmission [4]. TB incidence and rates of TB transmission vary considerably across communities and might be dependent on high-risk behaviors, social determinates of disease (e.g., malnutrition, overcrowding, poverty), population dynamics, and transmission venues [10,11,12]. The design of effective, targeted TB interventions should be tailored to local epidemiology and program performance. In this population-based study, named the Kopanyo Study, we used a multidisciplinary approach combining classic epidemiologic approaches (i.e., relying on the behavioral, clinical, demographical, geospatial, social, and temporal characteristics of cases) with mycobacterial genetics to describe TB transmission in 2 large districts in Botswana
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