Prevalence and risk factors for Mycobacterium tuberculosis infection among adolescents in rural South Africa

Abstract Background We aimed to estimate the prevalence of and explore risk factors for Mycobacterium tuberculosis infection among adolescents in a high tuberculosis (TB) and HIV prevalence setting. Methods A cross-sectional study of adolescents (10–19 years) randomly selected from a demographic surveillance area (DSA) in rural KwaZulu-Natal, South Africa. We determined M. tuberculosis infection status using the QuantiFERON-TB Gold-plus assay. We used HIV data from the DSA to estimate community-level adult HIV prevalence and random effects logistic regression to identify risk factors for TB infection. Results We enrolled 1,094 adolescents (548 [50.1%] female); M. tuberculosis infection prevalence (weighted for non-response by age, sex, and urban/rural residence) was 23.0% (95% confidence interval [CI]: 20.6–25.6%). M. tuberculosis infection was associated with older age (adjusted odds ratio [aOR]: 1.37; 95% CI: 1.10–1.71, for increasing age-group [12–14, 15–17, 18–19 vs. 10–11 years]), ever (vs. never) having a household TB contact (aOR: 2.13, 95% CI: 1.25–3.64) and increasing community-level HIV prevalence (aOR: 1.43, 95% CI: 1.07–1.92, for increasing HIV prevalence category [25–34.9%, 35–44.9%, ≥45% vs. l25%]). Conclusion Our data support prioritising TB prevention and care activities in TB-affected households and high HIV prevalence communities.