Latent tuberculosis infection prevalence in children with household tuberculosis contact in the city of Kyiv, Ukraine

Grantee

NGO "Infection Control in Ukraine", Ukraine

Project status: Completed

Main applicant and principal investigator

Mariia Dolynska, Medical Director, NGO "Infection Control in Ukraine"

Deputy applicant

Andrii Aleksandrin, Head, NGO "Infection Control in Ukraine"

Collaborators 

1. Robert C. Horsburgh, MD, Professor of Epidemiology, Biostatistics, Global Health and Medicine, Boston University, USA
2. Helen E. Jenkins, Ph.D., Assistant Professor of Biostatistics, School of Public Health, Boston University, USA
3. Natasha R. Rybak MD, Medical Director, RISE Tuberculosis Clinic, the Miriam Hospital; Assistant Professor of Medicine, Clinician Educator, Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Rhode Island, USA
4. Alexander Trusov, MD, Ph.D., Senior Technical Advisor of NGO “MAD Consulting”, Kazakhstan

Background

Prevention of latent tuberculosis infection (LTBI) progression to TB disease is critical for reducing the TB burden and achieving the End TB Strategy targets set for 2030 and 2035. Currently, there are no reliable data on the LTBI rate in Ukraine and no published data on the relative risk (RR) of LTBI in children with household TB contacts compared with children in the community. National LTBI screening programme is mainly based on tuberculin skin tests (TST) resulting in a high proportion of false-positive results in a population where 95% receive BCG-vaccination at birth. Interferon Gamma Release Assay (IGRA) testing, a more precise method, is almost inaccessible in Ukraine due to its high cost. However, the accurate estimate of LTBI are necessary to plan interventions related to LTBI treatment.

Objective

The overall study objective was to assess the LTBI positivity rate in children exposed to TB contacts and estimate the number of children needing LTBI treatment per TB index case. We hypothesized that we would find a large number of TB infected children in TB exposed households but that we would find a substantial number of TB infected children in control (non-TB exposed) households too.

Methods

Children from 5 to 15 years old residing in the eastern part of the city of Kyiv (three city districts at the Dnipro's Left Bank) were enrolled into a case-control study: 74 TB household exposed children, identified through contact tracing among TB patients, and 105 non-household exposed children, recruited through a primary health care facility. LTBI positivity was assessed through IGRA testing.

Results

The LTBI rate was 25,4% in the exposure group and 6,3% in the community group. Compared to non-household contacts, household contacts have a LTBI odds ratio of 5.04 (95% CI: 1.98-14.62; p = 0.001).

Conclusions / impact

The study generated the first-ever preliminary estimates of LTBI prevalence among children with and without household contacts in Ukraine. This pilot study data has provided initial evidence for improving the programmatic management of latent TB screening and treatment in Ukraine and laid the foundation for future large-scale research projects aimed at identifying the priority groups for LTBI testing and preventive therapy in Ukraine.

More information 

A full publication of the study is forthcoming and will be made available here once published.