The effectiveness of isoniazid preventive treatment among contacts of multidrug-resistant tuberculosis: a systematic review and individual-participant meta-analysis.

Background

To evaluate the association between isoniazid TB preventive treatment (TPT), compared to no treatment, upon incident TB in household contacts of MDR-TB cases using a large global consortium of TB contact tracing studies.

使用一个大型全球结核病接触者追踪研究联盟，评估异烟肼结核病预防治疗（TPT）与未治疗相比，对耐多药结核病（MDR-TB）家庭接触者发生结核病的影响。

Methods

We conducted a systematic reviewand individual-participant meta-analysisamong observational studies of household contact tracing studies.

我们在家庭接触者追踪研究的观察性研究中进行了系统评价和个体参与者荟萃分析。

Participants were included if they were exposed to someone with MDR-TB and were given either 6 months of isoniazid TPT or no TPT.

如果参与者暴露于耐多药结核病（MDR-TB）患者，并且接受了6个月的异烟肼预防性治疗（TPT）或未接受TPT，则被纳入研究。

Our primary outcome was incident TB in contacts exposed to TB.

我们的主要结果是接触结核病患者后发生的结核病事件。

We derived adjusted hazard ratios (aHRs) using mixed-effects, multivariable survival regression models with study-level random effects.

我们使用混合效应多变量生存回归模型，结合研究级别的随机效应，计算了调整后的风险比（aHRs）。

The effectiveness of isoniazid TPT against incident TB was estimated through propensity score matching.

通过倾向评分匹配估计了异烟肼预防治疗对新发结核病的有效性。

measurements_and_main_results

We included participant-level data from 6668 contacts exposed to MDR-TB from 17 countries.

我们纳入了来自17个国家的6668名暴露于耐多药结核病（MDR-TB）的接触者个体数据。

The effectiveness of isoniazid TPT against incident TB in contacts of MDR-TB was 57% (aHR, 0.43 [95% CI, 0.26-0.71]) and did not appreciably change with adjustment for additional potential confounders.

异烟肼预防性治疗（TPT）对耐多药结核病（MDR-TB）接触者新发结核病的有效性为57%（调整后风险比aHR，0.43 [95% 置信区间，0.26-0.71]），并且在调整其他潜在混杂因素后，效果没有显著变化。

The reduction in incident TB was marginally greater among child (<20 years old) contacts (aHR, 0.51 [95% CI, 0.28-0.92) compared to adult contacts (aHR, 0.69 [95% CI, 0.22-2.20]).

在儿童（<20岁）接触者中，新发结核病的减少略大于成人接触者（儿童aHR，0.51 [95% CI, 0.28-0.92]；成人aHR，0.69 [95% CI, 0.22-2.20]）。

The reduction in incidencewas 73% (aHR, 0.27 [95% CI, 0.11-0.70]) in the first year of follow-up; effectiveness dropped to 60% (aHR, 0.40 [95% CI, 0.15-1.06]) from 12 to 23 months of follow-up and was nonsignificant after 2 years (28% effectiveness; aHR, 0.72 [95% CI, 0.33-1.54]).

在随访的第一年中，发病率降低了73%（aHR，0.27 [95% CI，0.11-0.70]）；从随访的第12个月到第23个月，有效性降至60%（aHR，0.40 [95% CI，0.15-1.06]），而在2年后，有效性不显著（28%的有效性；aHR，0.72 [95% CI，0.33-1.54]）。

Conclusions

Among >6500 contacts of MDR-TB, isoniazid TPT was highly effective in preventing incident TB.

在超过6500名MDR-TB接触者中，异烟肼预防性治疗（TPT）在预防新发结核病方面非常有效。

The reduction was greatest in high-burden countries and waned after 2 years of follow-up.

减少幅度在高负担国家最大，并在随访2年后减弱。