A case control study to identify community venues associated with genetically clustered Multidrug-resistant Tuberculosis disease in Lima, Peru

The majority of tuberculosis transmission occurs in community settings. The primary aim of this study was to assess the association between exposure to community venues and multidrug-resistant tuberculosis (MDR-TB) disease. The secondary aim was to describe the social networks of MDR-TB cases and controls. This case-control study was conducted in Lima, Peru. We recruited lab-confirmed MDR-TB cases and community controls matched on age and sex. Whole-genome sequencing was used to identify genetically-clustered cases. Venue-tracing interviews (nonblinded) were conducted to enumerate community venues frequented by participants. Logistic regression was used to assess the association between MDR-TB disease and person-time spent in community venues. A location-based social network was constructed with respondents connected if they reported frequenting the same venue and an exponential random graph model (ERGM) was fitted to model the network. We enrolled 59 cases and 65 controls. Participants reported 729 unique venues. Mean number of venues reported was similar in both groups (P=0.92). Cases reported spending more person-time (hours) in healthcare and transportation venues than controls (P<0.05). Person-time in healthcare venues (Adjusted Odds Ratio (OR)=1.67, P=0.01), schools (OR=1.53, P<0.01), and transportation (OR=1.25, P=0.03) was associated with MDR-TB disease. Healthcare venues, markets, cinemas, and transportation venues were commonly shared among clustered cases. The ERGM indicated significant community segregation between cases and controls. Case networks were more densely connected. Exposure to healthcare venues, schools and transportation was associated with MDR-TB disease. Intervention across the segregated network of case venues may be necessary to effectively stem transmission.