Integrating Early Tuberculosis States Into Contact Management in Peru

In settings with high tuberculosis (TB) burden, should a household contact management strategy using chest radiograph (CR)–guided treatment of early TB be favored over universal TB preventive therapy as recommended by the World Health Organization?In this decision analytical model based on 12 767 household contacts in Lima, Peru, CR-guided identification and treatment of early TB with a regimen for TB disease was more effective than universal TB preventive therapy, although it was associated with more serious adverse events, particularly among older adults.These findings suggest that CR-guided treatment for early TB is preferable for children and young adults in high-burden settings, with cautious consideration of serious adverse event risk in older populations.

Corresponding Author: Megan B. Murray, MD, ScD, Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, 4th Floor, Room 4A07, Boston, MA 02115 (megan_murray@hms.harvard.edu).

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