Prevalence and management of tuberculosis among people who use drugs in Abidjan, Ivory Coast

Background Although people who use drugs (PWUD) are a high-risk group for tuberculosis (TB), there is practically no data on TB prevalence in Ivory Coast. The aim of the study was to estimate pulmonary TB prevalence and assess the cascade of care with confirmed pulmonary TB (TB+) among PWUD in Abidjan. Methods The study targeted adult people who had used heroin and/or cocaine/crack in the previous six months. A first part consisted in a cross-sectional prevalence estimation survey using mobile facility testing in smoking spots. A multivariable logistic regression was performed to determine the factors associated with TB infection. In a second part, all participants who tested positive for pulmonary TB were offered follow-up for the duration of their treatment and invited to participate in a community-based support program (e.g. family mediation visits or self-support groups). Results Between October 2016 and May 2017, 545 PWUD were informed about the survey and 532 agreed to participate. Most of them were male (n = 484; 91.0%) single (n = 434; 81.6%), with an average age of 34.9 (SD 8.3) years. Drugs most commonly consumed were heroin and crack (n = 530; 99.6% and n = 353; 66.4% respectively) and were inhaled (i.e. smoked). Out of the 531 participants with an Xpert MTB/RIF® test result, 52 were diagnosed with pulmonary TB, i.e. a prevalence of 9.8%, 95% CI [7.5%-12.7%]. Among them, 17.3% had rifampicin-resistant TB. Factors significantly associated with TB infection in the multivariable analysis were: having been recruited in Treichville smoking spot (OR=2.0 [1.1 - 3.7]; p = 0.03), being unemployed (OR = 1.8 [1.0 - 3.4]; p = 0.05), and being co-infected with HIV (OR=3.3 [1.2 - 8.1]; p = 0.01); 60.0% of the patients were successfully treated. Conclusion TB prevalence among the PWUD is high. The community-based support model enables good treatment efficacy among this usually hard-to-reach population.