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Adusumelli Y, Tabatneck M, Sherman S, Lamb G, Sabharwal V, Goldmann D, Epee-Bounya A, Haberer JE, Sandora TJ, Campbell JI. Pediatric Tuberculosis Infection Care Facilitators and Barriers: A Qualitative Study. Pediatrics 2024; 153:e2023063949. [PMID: 38327249 DOI: 10.1542/peds.2023-063949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND A total of 700 000 US children and adolescents are estimated to have latent tuberculosis (TB) infection. Identifying facilitators and barriers to engaging in TB infection care is critical to preventing pediatric TB disease. We explored families' and clinicians' perspectives on pediatric TB infection diagnosis and care. METHODS We conducted individual interviews and small group discussions with primary care and subspecialty clinicians, and individual interviews with caregivers of children diagnosed with TB infection. We sought to elicit facilitators and barriers to TB infection care engagement. We used applied thematic analysis to elucidate themes relating to care engagement, and organized themes using a cascade-grounded pediatric TB infection care engagement framework. RESULTS We enrolled 19 caregivers and 24 clinicians. Key themes pertaining to facilitators and barriers to care emerged that variably affected engagement at different steps of care. Clinic and health system themes included the application of risk identification strategies and communication of risk; care ecosystem accessibility; programs to reduce cost-related barriers; and medication adherence support. Patient- and family-level themes included TB knowledge and beliefs; trust in clinicians, tests, and medical institutions; behavioral skills; child development and parenting; and family resources. CONCLUSIONS Risk identification, education techniques, trust, family resources, TB stigma, and care ecosystem accessibility enabled or impeded care cascade engagement. Our results delineate an integrated pediatric TB infection care engagement framework that can inform multilevel interventions to improve retention in the pediatric TB infection care cascade.
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Affiliation(s)
- Yamini Adusumelli
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | | | - Gabriella Lamb
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Vishakha Sabharwal
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | | | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas J Sandora
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
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2
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Campbell JI, Tabatneck M, Sun M, He W, Musinguzi N, Hedt-Gauthier B, Lamb GS, Domond K, Goldmann D, Sabharwal V, Sandora TJ, Haberer JE. Multicenter Analysis of Attrition from the Pediatric Tuberculosis Infection Care Cascade in Boston. J Pediatr 2023; 253:181-188.e5. [PMID: 36181869 DOI: 10.1016/j.jpeds.2022.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/12/2022] [Accepted: 09/23/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To characterize losses from the pediatric tuberculosis (TB) infection care cascade to identify ways to improve TB infection care delivery. STUDY DESIGN We conducted a retrospective cohort study of children (age <18 years) screened for TB within 2 Boston-area health systems between January 2017 and May 2019. Patients who received a tuberculin skin test (TST) and/or an interferon gamma release assay (IGRA) were included. RESULTS We included 13 353 tests among 11 622 patients; 93.9% of the tests were completed. Of 199 patients with positive tests for whom TB infection evaluation was clinically appropriate, 59.3% completed treatment or were recommended to not start treatment. Age 12-17 years (vs < 5 years; aOR 1.59; 95% CI, 1.32-1.92), non-English/non-Spanish language preference (vs English; aOR, 1.34; 95% CI, 1.02-1.76), and receipt of an IGRA (vs TST, aOR, 30.82; 95% CI, 21.92-43.34) were associated with increased odds of testing completion. Odds of testing completion decreased as census tract social vulnerability index quartile increased (ie, social vulnerability worsened; most vulnerable quartile vs least vulnerable quartile, aOR, 0.77; 95% CI, 0.60-0.99). Odds of completing treatment after starting treatment were higher in females (vs males; aOR, 2.35; 95% CI, 1.14-4.85) and were lower in patients starting treatment in a primary care clinic (vs TB/infectious diseases clinic; aOR, 0.44; 95% CI, 0.27-0.71). CONCLUSIONS Among children with a high proportion of negative TB infection tests, completion of testing was high, but completion of evaluation and treatment was moderate. Transitions toward IGRA testing will improve testing completion; interventions addressing social determinants of health are important to improve treatment completion.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | - Mary Tabatneck
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Mingwei Sun
- Center for Research Information Technology, Boston Children's Hospital, Boston, MA
| | - Wei He
- Center for Research Information Science and Computing, Massachusetts General Hospital, Boston, MA
| | - Nicholas Musinguzi
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Gabriella S Lamb
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Kezia Domond
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Vishakha Sabharwal
- Division of Pediatric Infectious Diseases, Boston Medical Center, Boston, MA
| | - Thomas J Sandora
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA
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3
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Campbell JI, Menzies D. Testing and Scaling Interventions to Improve the Tuberculosis Infection Care Cascade. J Pediatric Infect Dis Soc 2022; 11:S94-S100. [PMID: 36314552 DOI: 10.1093/jpids/piac070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tuberculosis (TB) preventive therapy (TPT) is increasingly recognized as the key to eliminating tuberculosis globally and is particularly critical for children with TB infection or who are in close contact with individuals with infectious TB. But many barriers currently impede successful scale-up to provide TPT to those at high risk of TB disease. The cascade of care in TB infection (and the related contact management cascade) is a conceptual framework to evaluate and improve the care of persons who are potential candidates for TPT. This review summarizes recent literature on barriers and solutions in the TB infection care cascade, focusing on children in both high- and low-burden settings, and drawing from studies on children and adults. Identifying and closing gaps in the care cascade will require the implementation of tools that are new (e.g. computer-assisted radiography) and old (e.g. efficient contact tracing), and will be aided by innovative implementation study designs, quality improvement methods, and shared clinical practice with primary care providers.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dick Menzies
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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4
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Sawka A, Geake J, Stapledon R, Barry S. TB, focussed tools, and the right schools: estimated impact and cost of a targeted student screening program for tuberculosis infection. Intern Med J 2022. [PMID: 35289041 DOI: 10.1111/imj.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The WHO recommends targeted screening for latent tuberculosis infection (LTBI) amongst high-risk populations. Recent studies that evaluate targeted school- based programmes in low burden settings are scarce. AIMS To evaluate a school screening programme for recently arrived migrant students from moderate and high tuberculosis (TB) burden countries and estimate 1- the number of cases of active TB that were prevented and 2- the cost per case of active TB prevented. METHODS Students were screened with tuberculin skin tests (TST) at schools with a high migrant population intake. Those with positive results were referred for specialist evaluation. Outcomes were retrospectively assessed using five years of prospectively collected data. Cost data were collected. Main outcomes measured were the number of children were diagnosed with LTBI who completed treatment, and programme costs. RESULTS Of 4728 student screened, 295(6.2%) were diagnosed with LTBI. Of these, 273 (92.5%) were offered preventive therapy, 242 (82.0%) commenced and 204 (69.2%) completed therapy. The number needed to screen (NNS) was 23 per completed course of preventive treatment for LTBI. Assuming a 10% lifetime risk of reactivation, the NNS was 386 per case of TB disease notification avoided. The cost of screening was $23 932 AUD per case of TB disease avoided. CONCLUSIONS This TB strategy is supported by the high rate of TB infection in the student group, the treatment uptake and completion rates. Cost-benefit is linked with lifetime risk of TB reactivation. Targeted school screening programmes represent an important opportunity for TB control in low-burden settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alice Sawka
- Respiratory advanced trainee, Department of respiratory medicine, Royal Adelaide Hospital, Port Rd, Adelaide, South Australia, 5000.,Clinical lecturer, university of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, South Australia, 5000
| | - James Geake
- Respiratory advanced trainee, Department of respiratory medicine, Royal Adelaide Hospital, Port Rd, Adelaide, South Australia, 5000.,Clinical lecturer, university of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, South Australia, 5000
| | - Richard Stapledon
- Respiratory advanced trainee, Department of respiratory medicine, Royal Adelaide Hospital, Port Rd, Adelaide, South Australia, 5000
| | - Simone Barry
- Respiratory advanced trainee, Department of respiratory medicine, Royal Adelaide Hospital, Port Rd, Adelaide, South Australia, 5000.,Clinical lecturer, university of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, South Australia, 5000
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5
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Campbell JI, Sandora TJ, Haberer JE. A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking. BMJ Glob Health 2021; 6:e004836. [PMID: 34016576 PMCID: PMC8141435 DOI: 10.1136/bmjgh-2020-004836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Identifying and treating children with latent tuberculosis infection (TB infection) is critical to prevent progression to TB disease and to eliminate TB globally. Diagnosis and treatment of TB infection requires completion of a sequence of steps, collectively termed the TB infection care cascade. There has been no systematic attempt to comprehensively summarise literature on the paediatric TB infection care cascade. METHODS We performed a scoping review of the paediatric TB infection care cascade. We systematically searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane and Embase databases. We reviewed articles and meeting abstracts that included children and adolescents ≤21 years old who were screened for or diagnosed with TB infection, and which described completion of at least one step of the cascade. We synthesised studies to identify facilitators and barriers to retention, interventions to mitigate attrition and knowledge gaps. RESULTS We identified 146 studies examining steps in the paediatric TB infection care cascade; 31 included children living in low-income and middle-income countries. Most literature described the final cascade step (treatment initiation to completion). Studies identified an array of patient and caregiver-related factors associated with completion of cascade steps. Few health systems factors were evaluated as potential predictors of completion, and few interventions to improve retention were specifically tested. CONCLUSIONS We identified strengths and gaps in the literature describing the paediatric TB infection care cascade. Future research should examine cascade steps upstream of treatment initiation and focus on identification and testing of at-risk paediatric patients. Additionally, future studies should focus on modifiable health systems factors associated with attrition and may benefit from use of behavioural theory and implementation science methods to improve retention.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Thomas J Sandora
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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6
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Faust L, McCarthy A, Schreiber Y. Recommendations for the screening of paediatric latent tuberculosis infection in indigenous communities: a systematic review of screening strategies among high-risk groups in low-incidence countries. BMC Public Health 2018; 18:979. [PMID: 30081879 PMCID: PMC6090746 DOI: 10.1186/s12889-018-5886-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculosis (TB) continues to be a global public health concern. Due to the presence of multiple risk factors such as poor housing conditions and food insecurity in Canadian Indigenous communities, this population is at particularly high risk of TB infection. Given the challenges of screening for latent TB infection (LTBI) in remote communities, a synthesis of the existing literature regarding current screening strategies among high-risk groups in low-incidence countries is warranted, in order to provide an evidence base for the optimization of paediatric LTBI screening practices in the Canadian Indigenous context. Methods A literature search of the Embase and Medline databases was conducted, and studies pertaining the evaluation of screening strategies or screening tools for LTBI in paediatric high-risk groups in low-incidence countries were included. Studies focusing on LTBI screening in Indigenous communities were also included, regardless of whether they focused on a paediatric population. Their results were summarized and discussed in the context of their relevance to screening strategies suitable to the Canadian Indigenous setting. Grey literature sources such as government reports or policy briefs were also consulted. Results The initial literature search returned 327 studies, with 266 being excluded after abstract screening, and 36 studies being included in the final review (original research studies: n = 25, review papers or policy recommendations: n = 11). In the examined studies, case identification and cost-effectiveness of universal screening were low in low-incidence countries. Therefore, studies generally recommended targeted screening of high-risk groups in low-incidence countries, however, there remains a lack of consensus regarding cut-offs for the incidence-based screening of high-risk communities, as well as regarding the utility and prioritization of individual risk-factor-based screening of high-risk groups. The utility of the TST compared to IGRAs for LTBI detection in the pediatric population also remains contested. Conclusions Relevant strategies for targeted screening in the Canadian Indigenous context include community-level incidence-based screening (screening based on geographic location within high-incidence communities), as well as individual risk-factor-based screening, taking into account pertinent risk factors in Indigenous settings, such as poor housing conditions, malnutrition, contact with an active case, or the presence of relevant co-morbidities, such as renal disease.
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Affiliation(s)
- Lena Faust
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Anne McCarthy
- Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yoko Schreiber
- Department of Medicine, University of Ottawa, Ottawa, Canada. .,Ottawa Hospital Research Institute, Ottawa, Canada.
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Guix-Comellas EM, Rozas-Quesada L, Velasco-Arnaiz E, Ferrés-Canals A, Estrada-Masllorens JM, Force-Sanmartín E, Noguera-Julian A. Impact of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: A nonrandomized controlled trial. J Adv Nurs 2018; 74:1819-1830. [PMID: 29726024 DOI: 10.1111/jan.13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the association of a new nursing intervention on the adherence to antituberculosis treatment in a paediatric cohort (<18 years). BACKGROUND Tuberculosis remains a public health problem worldwide. The risk of developing tuberculosis after primary infection and its severity are higher in children. Proper adherence to antituberculosis treatment is critical for disease control. DESIGN Nonrandomized controlled trial; Phase 1, retrospective (2011-2013), compared with Phase 2, prospective with intervention (2015-2016), in a referral centre for paediatric tuberculosis in Spain (NCT03230409). METHODS A total of 359 patients who received antituberculosis drugs after close contact with a smear-positive patient (primary chemoprophylaxis) or were treated for latent tuberculosis infection or tuberculosis disease were included, 261 in Phase 1 and 98 in Phase 2. In Phase 2, a new nurse-led intervention was implemented in all patients and included two educational steps (written information in the child's native language and follow-up telephone calls) and two monitoring steps (Eidus-Hamilton test and follow-up questionnaire) that were exclusively carried out by nurses. RESULTS Adherence to antituberculosis treatment increased from 74.7% in Phase 1% to 87.8% in Phase 2 (p = 0.014; Chi-square test), after the implementation of the nurse-led intervention. In Phase 2, nonadherence was only associated with being born abroad (28.6% vs. 7.8%; p = 0.019; Chi-square test) and with foreign origin families (27.3% vs. 0%; p < 0.0001; Chi-square test). CONCLUSION The nurse-led intervention was associated to an increase in adherence to antituberculosis treatment. Immigrant-related variables remained major risk factors for sub-optimal adherence in a low-endemic setting.
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Affiliation(s)
- Eva Maria Guix-Comellas
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Librada Rozas-Quesada
- Childhood Tuberculosis Specialist Unit, Nursing Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Eneritz Velasco-Arnaiz
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria, Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Ariadna Ferrés-Canals
- Childhood Tuberculosis Specialist Unit, Nursing Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Joan Maria Estrada-Masllorens
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Enriqueta Force-Sanmartín
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Antoni Noguera-Julian
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Ciberesp, Madrid, Spain
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8
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Lin S, Melendez-Torres GJ. Systematic review of risk factors for nonadherence to TB treatment in immigrant populations. Trans R Soc Trop Med Hyg 2017; 110:268-80. [PMID: 27198210 DOI: 10.1093/trstmh/trw025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/21/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Foreign-born populations carry a significant TB burden in low-prevalence countries, composing over half of all cases in parts of Europe and North America. This study systematically reviewed evidence of risk factors for nonadherence to TB drug therapy in this group. METHODS On 28 October 2013 MEDLINE, CINAHL, Embase, PsychINFO and ProQuest were systematically searched for studies examining adherence in foreign-born populations with TB. Grey literature and reference lists were hand-searched. Risk factor studies were selected for inclusion if they consisted of at least 95% foreign-born populations. RESULTS Of 1761 studies identified in the search, 20 were included in the risk factor review. Undocumented immigration status, older age, and social risk factors were consistently correlated with nonadherence; gender, ethnicity, immigration time, education level, adverse side effects, and HIV status were inconsistently correlated; and behavioural risk factors and marital status were consistently not correlated. CONCLUSIONS This review emphasizes documentation status as a risk factor candidate for further investigation.
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Affiliation(s)
- Stephanie Lin
- University of Oxford, Department of Social Policy and Intervention, Oxford, UK
| | - G J Melendez-Torres
- University of Oxford, Department of Social Policy and Intervention, Oxford, UK
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9
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Chernet A, Utzinger J, Sydow V, Probst-Hensch N, Paris DH, Labhardt ND, Neumayr A. Prevalence rates of six selected infectious diseases among African migrants and refugees: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2017; 37:605-619. [PMID: 29080108 DOI: 10.1007/s10096-017-3126-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/16/2017] [Indexed: 12/27/2022]
Abstract
The objective of this paper was to systematically review the literature on the prevalence of selected infectious diseases among migrants/refugees of African origin and to provide policy makers and health care professionals with evidence-based information. We pursued a systematic review and meta-analysis to determine the prevalence of six selected infectious diseases (i.e., syphilis, helminthiasis, schistosomiasis, intestinal protozoa infections, hepatitis B, and hepatitis C) among migrants/refugees of African origin. Three electronic databases (i.e., PubMed, EMBASE, and ISI Web of Science) were searched without language restrictions. Relevant data were extracted and random-effects meta-analyses conducted. Only adjusted estimates were analyzed to help account for heterogeneity and potential confounding. We assessed the quality of evidence using the GRADE approach. The results were stratified by geographical region. Ninety-six studies were included. The evidence was of low quality due to the small numbers of countries, infectious diseases, and participants included. African migrants/refugees had median (with 95% confidence interval [95% CI]) prevalence for syphilis, helminthiasis, schistosomiasis, intestinal protozoa infection, hepatitis B, and hepatitis C of 6.0% [95% CI: 2.0-7.0%], 13.0% [95% CI: 9.5-14.5%], 14.0% [95% CI: 13.0-17.0%], 15.0% [95% CI: 10.5-21.0%], 10.0% [95% CI: 6.0-14.0%], and 3.0% [95% CI: 1.0-4.0%], respectively. We found high heterogeneity regardless of the disease (I 2; minimum 97.5%, maximum 99.7%). The relatively high prevalence of some infectious diseases among African migrants/refugees warrants for systematic screening. The large heterogeneity of the available published data does not allow for stratifying such screening programs according to the geographical origin of African migrants/refugees.
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Affiliation(s)
- A Chernet
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - J Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - V Sydow
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - N Probst-Hensch
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - D H Paris
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - N D Labhardt
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - A Neumayr
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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10
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Adherence to Antituberculosis Drugs in Children and Adolescents in A Low-Endemic Setting: A Retrospective Series. Pediatr Infect Dis J 2017; 36:616-618. [PMID: 28030525 DOI: 10.1097/inf.0000000000001508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adherence to antituberculosis drug regimens is critical for the prevention and treatment of tuberculosis in pediatrics. In a large retrospective series of children and adolescents in Barcelona, Spain, completion of treatment was worse among patients treated for latent infection, compared with those treated for active tuberculosis or receiving primary chemoprophylaxis. Toxicity and cultural and language barriers were identified as predictors of nonadherence.
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11
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Alsdurf H, Hill PC, Matteelli A, Getahun H, Menzies D. The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:1269-1278. [PMID: 27522233 DOI: 10.1016/s1473-3099(16)30216-x] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND WHO estimates that a third of the world's population has latent tuberculosis infection and that less than 5% of those infected are diagnosed and treated to prevent tuberculosis. We aimed to systematically review studies that report the steps from initial tuberculosis screening through to treatment for latent tuberculosis infection, which we call the latent tuberculosis cascade of care. We specifically aimed to assess the number of people lost at each stage of the cascade. METHODS We did a systematic review and meta-analysis of study-level observational data. We searched MEDLINE (via OVID), Embase, and Health Star for observational studies, published between 1946 and April 12, 2015, that reported primary data for diagnosis and treatment of latent tuberculosis infection. We did meta-analyses using random and fixed effects analyses to identify percentages of patients with latent tuberculosis infection completing each step in the cascade. We also estimated pooled proportions in subgroups stratified by different characteristics of interest to assess risk factors for losses. RESULTS We identified 58 studies, describing 70 distinct cohorts and 748 572 people. Steps in the cascade associated with greater losses included completion of testing (71·9% [95% CI 71·8-72·0] of people intended for screening), completion of medical evaluation (43·7% [42·5-44·9]), recommendation for treatment (35·0% [33·8-36·4]), and completion of treatment if started (18·8% [16·3-19·7]). Steps with fewer losses included receiving test results, referral for evaluation if test positive, and accepting to start therapy if recommended. Factors associated with fewer losses were immune-compromising medical indications, being part of contact investigations, and use of rifamycin-based regimens. INTERPRETATION We identify major losses at several steps in the cascade of care for latent tuberculosis infection. Improvements in management of latent tuberculosis will need programmatic approaches to address the losses at each step in the cascade. FUNDERS Canadian Institutes of Health Research.
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Affiliation(s)
- Hannah Alsdurf
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Alberto Matteelli
- Global TB Programme, WHO, Geneva, Switzerland; Clinic of Infectious and Tropical Diseases, WHO Collaborating Center for TB/HIV and TB Elimination, University of Brescia, Brescia, Italy
| | | | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada; Global TB Programme, WHO, Geneva, Switzerland.
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12
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Sandgren A, Vonk Noordegraaf-Schouten M, van Kessel F, Stuurman A, Oordt-Speets A, van der Werf MJ. Initiation and completion rates for latent tuberculosis infection treatment: a systematic review. BMC Infect Dis 2016; 16:204. [PMID: 27184748 PMCID: PMC4869320 DOI: 10.1186/s12879-016-1550-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/07/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Control of latent tuberculosis infection (LTBI) is an important step towards tuberculosis elimination. Preventive treatment will prevent the development of disease in most cases diagnosed with LTBI. However, low initiation and completion rates affect the effectiveness of preventive treatment. The objective was to systematically review data on initiation rates and completion rates for LTBI treatment regimens in the general population and specific populations with LTBI. METHODS A systematic review of the literature (PubMed, Embase) published up to February 2014 was performed. RESULTS Forty-five studies on initiation rates and 83 studies on completion rates of LTBI treatment were found. These studies provided initiation rates (IR) and completion rates (CR) in people with LTBI among the general population (IR 26-99 %, CR 39-96 %), case contacts (IR 40-95 %, CR 48-82 %), healthcare workers (IR 47-98 %, CR 17-79 %), the homeless (IR 34-90 %, CR 23-71 %), people who inject drugs (IR 52-91 %, CR 38-89 %), HIV-infected individuals (IR 67-92 %, CR 55-95 %), inmates (IR 7-90 %, CR 4-100 %), immigrants (IR 23-97 %, CR 7-86 %), and patients with comorbidities (IR 82-93 %, CR 75-92 %). Generally, completion rates were higher for short than for long LTBI treatment regimens. CONCLUSION Initiation and completion rates for LTBI treatment regimens were frequently suboptimal and varied greatly within and across different populations.
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Affiliation(s)
- Andreas Sandgren
- Former Surveillance and Response Section, European Centre for Disease Prevention and Control (ECDC), Stockholm, 171 65, Sweden
| | | | - Femke van Kessel
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
| | - Anke Stuurman
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
| | - Anouk Oordt-Speets
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
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Pareek M, Greenaway C, Noori T, Munoz J, Zenner D. The impact of migration on tuberculosis epidemiology and control in high-income countries: a review. BMC Med 2016; 14:48. [PMID: 27004556 PMCID: PMC4804514 DOI: 10.1186/s12916-016-0595-5] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/08/2016] [Indexed: 02/08/2023] Open
Abstract
Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy.
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Affiliation(s)
- Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. .,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Christina Greenaway
- Division of Infectious Diseases and Department of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jose Munoz
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Dominik Zenner
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.,Centre for Infectious Disease Epidemiology, University College London, London, UK
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Abstract
BACKGROUND High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. OBJECTIVES We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. METHODS We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. RESULTS Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). LIMITATIONS The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. CONCLUSION Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.
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Lancella L, Lo Vecchio A, Chiappini E, Tadolini M, Cirillo D, Tortoli E, de Martino M, Guarino A, Principi N, Villani A, Esposito S, Galli L. How to manage children who have come into contact with patients affected by tuberculosis. J Clin Tuberc Other Mycobact Dis 2015; 1:1-12. [PMID: 31723675 PMCID: PMC6850253 DOI: 10.1016/j.jctube.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/14/2015] [Accepted: 07/05/2015] [Indexed: 11/21/2022] Open
Abstract
Childhood tuberculosis (TB) indicates a recent infection, particularly in children aged < 5 years, and therefore is considered a sentinel event insofar as it highlights the presence of an undiagnosed or untreated source case. The risk of acquiring TB is directly proportional to the number of bacilli to which a subject is exposed and the environment in which the contact occurred. This document contains the recommendations of a group of Italian scientific societies for managing a child exposed to a case of TB based on an analysis of the risk factors for acquiring latent tuberculous infection (LTBI) and developing the disease, and the particular aspects TB transmission during the first years of life. The guidance includes a detailed description of the methods used to identify the index case, the tests that the exposed child should receive and the possibilities of preventive chemoprophylaxis depending on the patient's age and immune status, the chemotherapy and monitoring methods indicated in the case of LTBI, the management of a child who has come into contact with a case of multidrug-resistant or extensively drug-resistant TB, and the use of molecular typing in the analysis of epidemics. The group of experts identified risk factors for tuberculous infection and disease in pediatric age as well as gave recommendation on management of contacts of cases of TB according to their age, risk factors and exposure to multidrug-resistant or extensively drug-resistant TB.
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Affiliation(s)
- Laura Lancella
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Andrea Lo Vecchio
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Elena Chiappini
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
| | - Marina Tadolini
- Section of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniela Cirillo
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Tortoli
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Villani
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
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Campbell JR, Chen W, Johnston J, Cook V, Elwood K, Krot J, Marra F. Latent Tuberculosis Infection Screening in Immigrants to Low-Incidence Countries: A Meta-Analysis. Mol Diagn Ther 2015; 19:107-17. [DOI: 10.1007/s40291-015-0135-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
La prise irrégulière ou le refus d’un traitement peuvent parfois être perçus comme une déviance ou une conduite anormale et modifier la relation entre le soignant et son patient. Le rôle des soignants consiste alors à ramener vers la norme les individus ne s’y conformant pas. La non-observance thérapeutique (la conduite) est un phénomène multidimensionnel. Néanmoins, la non-observance nécessite également d’interroger le point de vue des patients, c’est-à-dire l’adhésion thérapeutique (l’attitude). L’exploration des différentes rationalités qui modulent les trajectoires thérapeutiques des patients permet de saisir la complexité du lien entre les conduites et les attitudes. En nous appuyant sur une ethnographie réalisée à la Clinique de tuberculose d’un hôpital pédiatrique à Montréal (Québec, Canada), nous présentons une étude de cas qui permet d’approfondir la compréhension de l’observance (ou non) et de l’adhésion (ou non) thérapeutique. Des familles de l’Europe de l’Est sont au coeur de la réflexion. Certaines caractéristiques de ces familles mettent en avant des profils sociodémographiques qui modifient la rencontre clinique. Plus spécifiquement, l’accent est placé sur la pluralité des rationalités et des divergences au sein de la biomédecine, qui vient teinter les dynamiques relationnelles entre les familles et l’équipe soignante tout en exposant le déplacement des frontières entre les savoirs profanes et experts.
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Affiliation(s)
- Marie-Ève Carle
- CHU Sainte-Justine, Unité de Pédiatrie Interculturelle, 3175, Côte-Sainte-Catherine, Montréal (Québec) H3T 1C5, Canada
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Abstract
PURPOSE OF REVIEW The primary purpose is to review guidance on the testing and treatment of latent tuberculosis infection (LTBI) in children. Most children and adults with LTBI have positive tuberculin skin test (TST) or interferon gamma release assay (IGRA) results, normal examinations, and normal chest radiographs. Diagnosis of and treatment completion for LTBI are critical to diminish future cases of tuberculosis (TB) disease. RECENT FINDINGS Children should be screened for TB risk factors, and only children with risk factors should be tested with either a TST or an IGRA. IGRAs measure interferon gamma production by lymphocytes after they are stimulated ex vivo by antigens that are primarily Mycobacterium tuberculosis-specific. The foundation of LTBI therapy in the United States has been 9 months of daily isoniazid, but shorter treatment regimens now exist, including a 12-dose regimen of weekly isoniazid and rifapentine. These shorter regimens are associated with higher completion rates. SUMMARY There are two distinct modalities for LTBI diagnosis and several treatment regimens that can prevent TB disease in infected children. The selection of treatment regimen should take several factors into consideration, including adherence, drug susceptibility results of the presumed source case (if known), safety, cost, and patient preference.
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Chang SH, Eitzman SR, Nahid P, Finelli MLU. Factors associated with failure to complete isoniazid therapy for latent tuberculosis infection in children and adolescents. J Infect Public Health 2013; 7:145-52. [PMID: 24361084 DOI: 10.1016/j.jiph.2013.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/13/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Completion of the recommended 9-month course of isoniazid to treat latent tuberculosis infection in children remains poor and is often affected by adverse effects, including hepatitis, to medication. We evaluated the frequency of isoniazid therapy completion and factors associated with failure to complete therapy in patients aged 0-18 years. METHODS We performed a retrospective review of medical records for patients aged 0-18 years who were referred for isoniazid therapy between January 2005 and August 2011 at 2 California county sites: a public health department and a pediatric latent tuberculosis infection clinic. Medication adherence to isoniazid therapy was measured by monthly pill count. RESULTS There were 1872 eligible patients who were referred for isoniazid therapy. Of the 1587 patients who met inclusion criteria and initiated treatment, 1235 patients (78%) completed the 9-month therapy, including 1046 of 1308 patients aged <15 years (80%) and 189 of 268 patients aged 15-18 years (71%). Factors that were significantly associated with failure to complete therapy included age 15-18 years, non-Hispanic race, development of hepatitis, and symptoms of adverse effects. The association between age and the development of hepatitis was similar for male and female patients. CONCLUSION Failure to complete isoniazid therapy in patients aged 0-18 years is affected by older age, non-Hispanic race, development of hepatitis, and symptoms of adverse effects. Additional support is needed for adolescents to complete therapy for latent tuberculosis infection.
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Affiliation(s)
- Shiow-Huey Chang
- Public Health Department, Santa Clara County, San Jose, CA, United States.
| | - Sarah R Eitzman
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States; Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Payam Nahid
- Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, United States
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Successful treatment of pediatric latent tuberculosis infection in a community health center clinic. Pediatr Infect Dis J 2012; 31:e147-51. [PMID: 22531235 DOI: 10.1097/inf.0b013e318257f7c6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study evaluates completion of treatment for latent tuberculosis infection (LTBI) in Mexican immigrant children aged 1-18 years in a Community Health Center (CHC). METHODS Children were screened for LTBI at a CHC. All children with a tuberculin skin test (TST) ≥10 mm had a chest radiograph (CXR). Those with negative CXR had nurse appointments to collect demographic information and to begin 9 months of INH treatment. A minimum 6 months of INH treatment defined completion. RESULTS Between November 15, 2006 and March 15, 2009, 157 children had positive TSTs. Three never had a CXR, 2 had misdiagnosed LTBI and 2 had asymptomatic active tuberculosis. Of 150 with LTBI, 111 (74%) completed INH at CHC. Thirteen (9%) transferred care to school-based clinics or TB clinic (TBC) and 4 (3%) never started treatment. Twenty-two (15%) did not complete treatment at CHC. One developed INH hepatitis and 21 were lost to follow-up. Of 13 who transferred to school-based clinics/TBC, 10 completed therapy, with 121 (81%) completing treatment started at CHC. By logistic regression factors associated with not starting/incomplete LTBI treatment were older age, increased number of days between TST and CXR, and 0-1 well care visits versus ≥2 visits before TST placement. A visit co-pay ≥$15.00 was associated with transfer of care to school-based clinics/TBC. CONCLUSIONS Pediatric LTBI can be successfully treated by CHC nurses. Completion of treatment was associated with younger age, fewer days between TST reading and CXR, and being an established patient in the CHC.
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Fraisse P. Diagnostic des infections tuberculeuses latentes (sujets sains, sujets immunodéprimés ou amenés à l’être). Rev Mal Respir 2012; 29:277-318. [DOI: 10.1016/j.rmr.2011.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/11/2011] [Indexed: 01/30/2023]
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Cao H, Zhou Y, Brauer F. Estimates of tuberculosis progression rate of children in China. JOURNAL OF BIOLOGICAL DYNAMICS 2012; 6:663-673. [PMID: 22873611 DOI: 10.1080/17513758.2012.677483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this paper, a discrete mathematical model is formulated to describe tuberculosis (TB) progression from latent infection to active disease. The data of national TB epidemiology surveys in China are taken to estimate the TB progression rate for children aged 0-14 years. The progression rate obtained in this paper gives a detailed and better estimate of TB progression rate among children.
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Affiliation(s)
- Hui Cao
- Department of Applied Mathematics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
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