Background: Current guidelines recommend evaluation of household contacts (HHC) of individuals with multidrug-resistant tuberculosis (MDR-TB) but widespread implementation of this policy is challenging. Objective: To describe site-level resource utilization and operational challenges encountered when identifying, recruiting, and characterizing adult MDR-TB Index Cases and their HHC. Design: Cross-sectional study of adult MDR-TB Index Cases and HHC at 16 clinical research sites in 8 countries. Site-level resource utilization was assessed using structured surveys. Results: Between October 2015 and April 2016, 308 Index Cases and 1018 HHC were enrolled. Of 280 Index Cases with sputum collected, 94 were smear positive (34%, 95% Confidence Interval (CI): 28–39%) and of 201 with chest x-rays, 87 had cavitary disease (43%, CI: 37–50%) after a mean duration of treatment of 8 weeks. Staff required 512 attempts to evaluate the 308 households, median time per attempt of 4 hours. 77% (CI: 73─80%) of the HHC were at increased risk for TB: 13% < 5 years; 8% >5 years. and HIV-infected; and 79% >5 years, HIV-/unknown and TST/IGRA positive. 121 previously undiagnosed TB cases were identified. Issues identified by site staff included complexity of personnel and participant transportation, infection control, personnel safety and management of stigma surrounding household visits. Conclusion: Household contact investigations can be high yield but are labor intensive.