Paper Information

Between April 2021 and October 2023, we enrolled 750 PWSD. Overall, 71.5% (95% CI, 66.1%-76.8%) were male and the mean age was 34 years (95% CI, 33%-36%); 17.5% (95% CI, 13.0%-22.0%) were PWH, of whom 31.6% were newly diagnosed. RDS-adjusted TB prevalence was 10.4% (95% CI, 6.5%-14.3%). TB prevalence among PWSD without HIV was 8.1% (95% CI, 4.4%-11.9%), compared to 20.9% (95% CI, 8.4%-33.4%) with HIV. PWH had 3.3-fold greater adjusted odds of having TB disease (95% CI, 1.9%-5.8%).

PWSD identified through RDS had substantially elevated TB and HIV rates, with 20% of PWSD with HIV having TB. We successfully engaged PWSD in TB screening using peer recruitment. These findings highlight opportunities for community transmission identification and interventions.

Tuberculosis (TB) transmission is heterogenous, yet high-risk populations remain poorly defined. We aimed to assess whether people who smoke drugs (PWSD) have elevated TB disease rates in a high-burden setting.

We recruited PWSD from a rural community in the Western Cape, South Africa, using respondent-driven sampling (RDS). Participants were ≥15 years old, tested positive for methamphetamine and/or methaqualone, and completed TB and HIV testing and biobehavioral surveys. We defined TB disease as culturable TB, Xpert MTB/RIF Ultra (Ultra) MTB detected with no history of TB, Ultra traceamong persons with HIV (PWH) >2 years from any prior diagnosis, or currently on TB treatment. We summarized population-level characteristics and estimated TB prevalence using the RDS-II estimator. We identified characteristics associated with TB using logistic regression.