In the last ten years, the epidemiology, diagnosis and treatment of multidrug-resistant (MDR) or rifampicin-resistant tuberculosis (RR-TB) has substantially changed. Unfortunately, this was not accompanied by evidence-based guidance on how to manage and prevent the development of TB in household contacts of individuals with MDR/RR-TB.
However, in 2024, a meta-analysis of two randomised controlled trials (TB-CHAMP and V-QUIN) supported the use of levofloxacin for TB preventive treatment. Given this changing landscape, there was a need for these new data, along with other recent observational studies, to be reviewed and synthesised to enable front-line healthcare workers to effectively manage those exposed to MDR/RR-TB.
The review was authored by a diverse team comprising academics, researchers, national TB programme directors, and representatives from public health and non-governmental organisations, including members of The Union.
It aimed to review the evidence and propose approaches to conduct household contact management. This article was published on 5 June 2025, in Lancet Infectious Diseases.
As James Seddon, the first author, comments: “Preventing TB in household contacts of individuals with MDR/RR-TB is not merely about offering TB preventive treatment (TPT). Risk stratification is essential in order to appropriately select who will benefit from TPT, and this includes consideration of index patient characteristics (e.g. age or disease severity), household contact characteristics (e.g. age, HIV status and other comorbidities) and their patterns of interaction (e.g. closeness of contact).”
Leo Martinez, the senior author, further comments: “Social determinants also play an important role in determining which contacts progress from infection to disease, and there is increasing evidence suggesting that interventions can reduce this risk. Examples include improved nutrition and providing financial support. Due recognition of these determinants can improve TPT uptake and ensure positive preventive treatment outcomes.”
The review discusses the risk stratification process and how to address social determinants, and, in a pragmatic, informative figure with accompanying narrative, outlines the key thought processes that need to be followed in order to optimise household contact management.
Anthony Harries, one of The Union co-authors, comments: “Despite reviewing the most up-to-date evidence, our understanding of how best to manage these household contacts is still incomplete. The Review ends by outlining the outstanding questions, research priorities and possible study designs to improve our understanding and implementation of managing individuals exposed to individuals with MDR/RR-TB.”
Those interested in knowing more about the subject are encouraged to read the paper here.