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Introduction: Tuberculosis control remains an ongoing challenge for low and middle-income countries with lack of understanding of the factors determining transmission of infection. This study aimed to investigate the impact of alcohol use among pulmonary tuberculosis patients on transmission to their household contacts in Puducherry and adjoining districts of Tamil Nadu, India.

Methodology: Data from a large-scale cohort comprising TB patients and their household contacts were analyzed. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire, while the infection was evaluated via the Mantoux test using an approved Tuberculin/PPD product. Mediation analysis explored the relationship between alcohol consumption, TB infection, and potential mediators.

Results: A substantial proportion of TB patients reported alcohol use (59.9%), and a significant association was found between smear positivity and LTBI infection among household contacts. Its reported prolonged exposure to tuberculosis was reported, with a majority (76.1%) spending >6 hours/day in proximity. However,lower LTBI positivity of 43.1% (95% CI 37.4%, 48.6%) was observed among the HHCs of TB patients with high-risk of alcohol use as compared to 53.9% (95% CI 51.2%, 56.5%) in the HHCs of ICs with low risk of alcohol. Alcohol use was associated with decreased time spent with household contacts, partially mediating the relationship between alcohol use and LTBI.

Conclusion: The study underscores the complex interplay between alcohol use, transmission dynamics, and household interactions. Strategies targeting alcohol reduction alongside TB control efforts are crucial for mitigating the transmission. Addressing alcoholism is imperative in TB control interventions. Further research is needed to elucidate transmission dynamics and develop targeted interventions. Keywords: tuberculosis, alcohol use, household contacts, transmission, smear positivity, LTBI