THE TREATMENT CASCADE: THE USE OF PREVENTATIVE PHARMACOTHERAPY FOR LATENT TB INFECTION FOLLOWING HIGH RISK NOSOCOMIAL EXPOSURE TO MULTIDRUG-RESISTANT TB

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: This observational cohort study assessed the uptake and tolerability of preventative therapy for high-risk contacts of an index case with smear positive pulmonary MDR-TB across two tertiary hospitals in Sydney, Australia. With almost half a million new cases of multidrug resistant tuberculosis (MDR-TB) in 2018, active case finding and consideration of preventative therapy among specific high-risk contacts is a top priority. Patient acceptance and tolerability of preventative for latent MDR-TB was examined through a telephone delivered questionnaire. METHODS: Contacts were investigated if they had a high risk of exposure, defined as greater than 8 hours of close contact with the index case during the period of infectiousness. After the exclusion of active tuberculosis, contacts with evidence of latent tuberculosis were offered a 9-month course of a fluoroquinolone (moxifloxacin) and all were followed with chest X-ray and clinical review for two years from exposure. Following informed consent, contacts were further invited to complete a questionnaire relating to their experience. RESULTS: In total, 122 people were identified as having high risk exposure to the index case (household contacts, patients and health care workers). Of these, 94 (77%) attended an initial assessment in the chest clinic and 32 (34%) had evidence of latent tuberculosis (positive IGRA or TST). Of the 32 high-risk MDR-TB contacts with latent tuberculosis, 22 choose ongoing CXR surveillance, 9 commenced preventative treatment and 1 did not attend follow up. Reasons cited for not choosing preventative therapy were risks of adverse side effects and concerns about negative job consequences. Of those that took preventative pharmacotherapy, 7 of 9 (78%) attended final 2-year follow up. 6 of 7 (86%) patients treated for latent tuberculosis completed the prescribed course. No cases of incident tuberculosis were detected after 2 years of follow up. CONCLUSIONS: Preventative therapy with moxifloxacin was tolerated well by high risk MDR-TB contacts with evidence of latent tuberculosis infection; however uptake of preventive therapy was limited. CLINICAL IMPLICATIONS: Each case of MDR-TB disease may expose multiple people to their disease and it is known that these people are at an increased risk of developing tuberculosis disease in the future, there is a lack of high quality evidence on the effectiveness of preventative therapy. Research that explores patient acceptance and tolerability of preventative for latent MDR-TB is lacking. Our study adds to the body of knowledge in ascertaining how to treat and manage high risk contacts of MDR-TB disease. DISCLOSURES: no disclosure on file for Byrne Anthony; No relevant relationships by Liam Beiglari, source=Web Response Recipient of study drug (rifapentine) relationship with Sanofi Please note: $20001 - $100000 Added 06/20/2019 by Greg Fox, source=Web Response, value=in kind supply of study drug No relevant relationships by PAUL LILBURN, source=Web Response