Household Clustering of High-Risk Contacts in Smear-Positive TB Patient Families: Evidence for Hotspot Households and Risk Stratification in Rural Eastern Cape

TB risk is highly clustered at the household level, with large families and young children carrying disproportionate vulnerability. Combining demographic risk assessment, household-level visualization, and predictive modeling provides a practical, data-driven approach to prioritizing households during contact investigation. These findings support the WHO's family-centered strategy and underscore the need to strengthen clinical governance and community-engaged education to optimize TB prevention in resource-limited rural settings.