Gupta A, Swindells S, Kim S, et al. - Researchers performed a cross-sectional study of 1,016 household contacts (HHCs) from 284 multidrug-resistant tuberculosis (TB) cases in 8 countries with high TB burdens in order to inform the development of an interventional clinical trial. Symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing were undertaken in HHCs. They identified 121 (12%) HHCs in whom TB developed: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) of 72% was observed; the prevalence varied by age, the test used, and the country. This suggests that the majority of HHCs were at high risk of TB disease and infection in these high-burden countries, however, only a few were receiving routine preventive therapy. This work highlight the urgent necessity for trials of novel, preventive therapies to inform treatment policy and practice.