Abstract
People who use illicit drugs (PWUDs) have been identified as a key at-risk group for tuberculosis (TB). Examination of illicit drug use networks has potential to assess the risk of TB exposure and disease progression. Research also is needed to assess mechanisms for accelerated TB transmission in this population. This study aims to 1) assess the rate of TB exposure, risk of disease progression, and disease burden among PWUD; 2) estimate the proportion of active TB cases resulting from recent transmission within this network; and 3) evaluate whether PWUD with TB disease have physiologic characteristics associated with more efficient TB transmission. Our cross-sectional, observational study aims to assess TB transmission through illicit drug use networks, focusing on methamphetamine and Mandrax (methaqualone) use, in a high TB burden setting and identify mechanisms underlying accelerated transmission. We will recruit and enroll 750 PWUD (living with and without HIV) through respondent driven sampling in Worcester, South Africa. Drug use will be measured through self-report and biological measures, with sputum specimens collected to identify TB disease by Xpert Ultra (Cepheid) and mycobacterial culture. We will co-enroll those with microbiologic evidence of TB disease in Aim 2 for molecular and social network study. Whole genome sequencing of Mycobacteria tuberculosis (Mtb) specimens and social contact surveys will be done for those diagnosed with TB. For Aim 3, aerosolized Mtb will be compared in individuals with newly diagnosed TB who do and do not smoke illicit drug. Knowledge from this study will provide the basis for a strategy to interrupt TB transmission in PWUD and provide insight into how this fuels overall community transmission. Results have potential for informing interventions to reduce TB spread applicable to high TB and HIV burden settings. Trial registration: Clinicaltrials.gov Registration Number: NCT041515602. Date of Registration: 5 November 2019.
Highlights
Tuberculosis (TB) is one of the leading infectious diseases globally that cause death, including among people living with human immunodeficiency virus (HIV) (PLHIV) [1]
We aim to evaluate whether people who use drugs (PWUD) with TB disease have physiologic characteristics associated with more efficient TB transmission compared to people with TB disease who do not use drugs
For Aim 2, other studies have consistently estimated that individuals who are in close contact with one another are linked by Whole Genome Sequencing (WGS) in more than 70% of the sample [55]
Summary
Tuberculosis (TB) is one of the leading infectious diseases globally that cause death, including among people living with HIV (PLHIV) [1]. An effective method to reduce TB incidence and mortality is to interrupt transmission, which requires finding and treating individuals with subclinical and clinical TB disease early. Molecular epidemiologic studies and mathematical models have shown that household contact tracing, our primary approach to case finding, identifies less than 19% of transmissions in high TB and TB/HIV burden settings [2]. There is a clear need to identify additional risk groups and settings where TB transmission occurs. New approaches have focused on congregate settings, such as prisons and healthcare facilities, to identify additional TB transmission [3]. A major source of transmission may exist in venues where individuals smoke illicit drugs, making these social networks potential amplifiers for the broader population epidemic and a group to target for transmission interventions
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