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Chawla K, Burugina Nagaraja S, Siddalingaiah N, Sanju C, Kumar U, Shenoy VP, Shastri S, Singarajipur A. Tuberculosis screening for pediatric household contacts in India: Time to adapt newer strategies under the National TB Elimination Programme! PLoS One 2023; 18:e0292387. [PMID: 37796796 PMCID: PMC10553317 DOI: 10.1371/journal.pone.0292387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION The study aimed to evaluate the effectiveness of screening pediatric household contacts (under the age of 15 years) for tuberculosis (TB) in India through verbal screening, tuberculin skin testing, and chest radiography at intervals of 0, 3, 6, 9, and 12 months. The study also aimed to determine the proportion of contacts who tested positive for TB and to describe the challenges in implementing regular follow-up. Current National TB Elimination Programme (NTEP) guidelines only require verbal screening for contacts under 6 years old at TB treatment initiation. The study aimed to fill this knowledge gap and provide valuable insights for improving TB screening in pediatric household contacts in India. METHODS The study was conducted in two districts of Karnataka, India from 2021 to 2022, and utilized a cohort study design to enroll contacts of index tuberculosis (TB) cases diagnosed under the National TB Elimination Programme (NTEP). Participants were followed up at regular intervals for one year to evaluate the effectiveness of TB screening in pediatric household contacts. RESULTS In this study, 686 pediatric household contacts were enrolled and screened for tuberculosis (TB) using verbal symptom screening, tuberculin skin testing (TST), and chest radiography. Projected figures estimated that 0.8%, 42%, and 4% of contacts would test positive for symptomatic screening, TST, and chest radiography, respectively. TB cases were detected in 2.91% (1.84-4.38) of contacts, with females above 6 years of age having a 22% higher risk of contracting the infection than males above 6 to < 15 years. However, not all cases were subjected to TST and chest radiography. The primary reason for not investigating child contact for TB was their reported healthy or asymptomatic status. CONCLUSION The implementation of regular screening intervals for tuberculin skin test (TST) and chest radiography, along with verbal screening, among pediatric household contacts under the age of 15 years seems to be beneficial for the National TB Elimination Programme (NTEP), despite the challenges faced during implementation. Innovative strategies should be explored by NTEP to ensure effective implementation.
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Affiliation(s)
- Kiran Chawla
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal, Manipal, Karnataka, India
| | - Sharath Burugina Nagaraja
- Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Bengaluru, Karnataka, India
| | - Nayana Siddalingaiah
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal, Manipal, Karnataka, India
| | | | - Uday Kumar
- Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Bengaluru, Karnataka, India
| | - Vishnu Prasad Shenoy
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal, Manipal, Karnataka, India
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Sangma VSC, Jaggi S, Saini V, Aggarwal D, Kumar P, Chander J. Prevalence of latent tuberculosis infection in household contacts of pulmonary tuberculosis, time to treat. Monaldi Arch Chest Dis 2023; 94. [PMID: 37218425 DOI: 10.4081/monaldi.2023.2563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
Treatment of latent pulmonary tuberculosis (TB) in household contacts has been included in the National Tuberculosis Elimination Program to achieve the target of TB elimination by the Government of India by 2025. However, there are no clear estimates of the prevalence of latent TB among the contacts that could suggest the impact of this intervention. The study was conducted to determine the prevalence of and factors predicting latent TB among household contacts with pulmonary TB. All microbiologically confirmed pulmonary TB patients registered between January 2020 and July 2021 and their household contacts were enrolled. All contacts underwent Mantoux testing to determine the prevalence of latent TB. All symptomatic patients also underwent chest radiographs and sputum examinations to diagnose active pulmonary TB. Thereafter, different demographic and clinical factors were evaluated to find predictors of latent TB using a logistic regression model. A total of 118 pulmonary TB cases and their 330 household contacts were enrolled. The prevalence of latent TB and active TB among the contacts was found to be 26.36% and 3.03%, respectively. The female gender of index TB cases was independently associated with a high proportion of latent TB cases in the family (adjusted odds ratio 2.32; 95% confidence interval 1.07-5.05; p=0.03). Neither the higher sputum smear positivity nor the severity of the chest radiograph of index TB cases had any association with the number of contacts being diagnosed as latent TB or active TB. The results showed a significant prevalence of latent TB among household contacts with pulmonary TB. The severity of the disease in the index patient had no association with the prevalence of latent TB.
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Affiliation(s)
- Vinnie Sarah Ch Sangma
- Department of Critical Care, Pushpawati Singhania Hospital and Research Institute, New Delhi.
| | - Surabhi Jaggi
- Department of Tuberculosis and Respiratory Diseases, Government Medical College and Hospital, Chandigarh.
| | - Varinder Saini
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh.
| | - Deepak Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh.
| | - Pankaj Kumar
- epartment of Pediatrics, Government Medical College and Hospital, Chandigarh.
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh.
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Sagili KD, Muniyandi M, Shringarpure K, Singh K, Kirubakaran R, Rao R, Tonsing J, Sachdeva KS, Tharyan P. Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries - a systematic review and meta-analysis. Trop Med Int Health 2022; 27:842-863. [PMID: 35927930 PMCID: PMC9825928 DOI: 10.1111/tmi.13808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To summarise latent tuberculosis infection (LTBI) management strategies among household contacts of bacteriologically confirmed pulmonary tuberculosis (TB) patients in high-TB burden countries. METHODS PubMed/MEDLINE (NCBI) and Scopus were searched (January 2006 to December 2021) for studies reporting primary data on LTBI management. Study selection, data management and data synthesis were protocol-driven (PROSPERO-CRD42021208715). Primary outcomes were the proportions of LTBI, initiating and completing tuberculosis preventive treatment (TPT). Reported factors influencing the LTBI care cascade were qualitatively synthesised. RESULTS From 3694 unique records retrieved, 58 studies from 23 countries were included. Most identified contacts were screened (median 99%, interquartile range [IQR] 82%-100%; 46 studies). Random-effects meta-analysis yielded pooled proportions for: LTBI 41% (95% confidence interval [CI] 33%-49%; 21,566 tested contacts); TPT initiation 91% (95% CI 79%-97%; 129,573 eligible contacts, 34 studies); TPT completion 65% (95% CI 54%-74%; 108,679 TPT-initiated contacts, 28 studies). Heterogeneity was significant (I2 ≥ 95%-100%) and could not be explained in subgroup analyses. Median proportions (IQR) were: LTBI 44% (28%-59%); TPT initiation 86% (60%-100%); TPT completion 68% (44%-82%). Nine broad themes related to diagnostic testing, health system structure and functions, risk perception, documentation and adherence were considered likely to influence the LTBI care cascade. CONCLUSION The proportions of household contacts screened, detected with LTBI and initiated on TPT, though variable was high, but the proportions completing TPT were lower indicating current strategies used for LTBI management in high TB burden countries are not sufficient.
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Affiliation(s)
- Karuna Devi Sagili
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | - Malaisamy Muniyandi
- Indian Council of Medical Research (ICMR)National Institution for Research in TuberculosisChennaiIndia
| | | | - Kavita Singh
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | | | - Raghuram Rao
- National TB Elimination Program, Central TB DivisionMinistry of HealthNew DelhiIndia
| | - Jamhoih Tonsing
- Technical Advice and Partnerships DepartmentThe Global FundGenevaSwitzerland
| | - Kuldeep Singh Sachdeva
- International Union Against Tuberculosis and Lung DiseaseSouth East Asia OfficeNew DelhiIndia
| | - Prathap Tharyan
- Clinical Epidemiology UnitChristian Medical CentreVelloreIndia
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Miller PB, Zalwango S, Galiwango R, Kakaire R, Sekandi J, Steinbaum L, Drake JM, Whalen CC, Kiwanuka N. Association between tuberculosis in men and social network structure in Kampala, Uganda. BMC Infect Dis 2021; 21:1023. [PMID: 34592946 PMCID: PMC8482622 DOI: 10.1186/s12879-021-06475-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background Globally, tuberculosis disease (TB) is more common among males than females. Recent research proposes that differences in social mixing by sex could alter infection patterns in TB. We examine evidence for two mechanisms by which social-mixing could increase men’s contact rates with TB cases. First, men could be positioned in social networks such that they contact more people or social groups. Second, preferential mixing by sex could prime men to have more exposure to TB cases. Methods We compared the networks of male and female TB cases and healthy matched controls living in Kampala, Uganda. Specifically, we estimated their positions in social networks (network distance to TB cases, degree, betweenness, and closeness) and assortativity patterns (mixing with adult men, women, and children inside and outside the household). Results The observed network consisted of 11,840 individuals. There were few differences in estimates of node position by sex. We found distinct mixing patterns by sex and TB disease status including that TB cases have proportionally more adult male contacts and fewer contacts with children. Conclusions This analysis used a network approach to study how social mixing patterns are associated with TB disease. Understanding these mechanisms may have implications for designing targeted intervention strategies in high-burden populations.
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Affiliation(s)
- Paige B Miller
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
| | | | | | - Robert Kakaire
- Global Health Institute, College of Public Health, University of Georgia, 100 Foster Drive, Athens, GA, 30602, USA
| | - Juliet Sekandi
- Global Health Institute, College of Public Health, University of Georgia, 100 Foster Drive, Athens, GA, 30602, USA
| | - Lauren Steinbaum
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | - John M Drake
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
| | - Christopher C Whalen
- Global Health Institute, College of Public Health, University of Georgia, 100 Foster Drive, Athens, GA, 30602, USA. .,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, 30602, USA.
| | - Noah Kiwanuka
- Makerere University School of Public Health, Kampala, Uganda
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Araújo NCN, Cruz CMS, Arriaga MB, Cubillos-Angulo JM, Rocha MS, Silveira-Mattos PS, Matos GM, Marques IMB, Espirito Santo ICP, Almeida LL, Andrade CM, Souza LA, Netto EM, Andrade BB. Determinants of losses in the latent tuberculosis cascade of care in Brazil: A retrospective cohort study. Int J Infect Dis 2020; 93:277-283. [PMID: 32081776 PMCID: PMC7245517 DOI: 10.1016/j.ijid.2020.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The present study evaluated factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of tuberculosis (TB) patients, in a referral center from a highly endemic region in Brazil. Methods: Contacts of 1672 TB patients were retrospectively studied between 2009 and 2014. Data on TB screening by clinical investigation, radiographic examination and tuberculin skin test (TST) were extracted from medical records. Losses in the cascade of care and TB incidence within 2-year follow-up were calculated. Results: From a total of 1180 TB contacts initially identified, only 495 were examined (58% loss), and 20 were diagnosed with active TB at this stage. Furthermore, 435 persons returned for TST result interpretation and 351 (~81%) were TST positive. Among those with positive TST, 249 (73%) were treated with isoniazid for 6 months whereas 51 abandoned therapy early. Three individuals who did not receive LTBI treatment, one with incomplete treatment and another who completed treatment developed active TB. A logistic regression analysis revealed that increases in age were associated with losses in the LTBI cascade independent of other clinical and epidemiological characteristics. Conclusions: Major losses occur at initial stages and older patients are at higher risk of not completing the LTBI cascade of care.
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Affiliation(s)
- Nélia C N Araújo
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Bahia, Brazil; Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Constança M S Cruz
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil
| | - María B Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Bahia, Brazil; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Juan M Cubillos-Angulo
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Bahia, Brazil; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Michael S Rocha
- Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Bahia, Brazil
| | - Paulo S Silveira-Mattos
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Bahia, Brazil; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Bahia, Brazil
| | - Gisela M Matos
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | | | - Luiza L Almeida
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | - Leonardo A Souza
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - Eduardo M Netto
- Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, Brazil; Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Bruno B Andrade
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Bahia, Brazil; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Bahia, Brazil; Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.
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Putra IWGAE, Kurniasari NMD, Dewi NPEP, Suarjana IK, Duana IMK, Mulyawan IKH, Riono P, Alisjahbana B, Probandari A, Notobroto HB, Wahyuni CU. The Implementation of Early Detection in Tuberculosis Contact Investigation to Improve Case Finding. J Epidemiol Glob Health 2019; 9:191-197. [PMID: 31529937 PMCID: PMC7310818 DOI: 10.2991/jegh.k.190808.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/03/2019] [Indexed: 11/25/2022] Open
Abstract
The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.
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Affiliation(s)
- I Wayan Gede Artawan Eka Putra
- Faculty of Public Health, Universitas Airlangga, Kampus C, Surabaya, East Java, Indonesia.,School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - Ni Made Dian Kurniasari
- School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | | | - I Ketut Suarjana
- Faculty of Public Health, Universitas Airlangga, Kampus C, Surabaya, East Java, Indonesia.,School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - I Made Kerta Duana
- School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - I Ketut Hari Mulyawan
- School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - Pandu Riono
- Faculty of Public Health, Universitas Indonesia, Depok City, West Java, Indonesia
| | - Bachti Alisjahbana
- Faculty of Medicine, Universitas Padjajaran, Jl. Professor Eyckman, Bandung, West Java, Indonesia
| | - Ari Probandari
- Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami, Surakarta City, Central Java, Indonesia
| | - Hari Basuki Notobroto
- Faculty of Public Health, Universitas Airlangga, Kampus C, Surabaya, East Java, Indonesia
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