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Kyaw WM, Lim LKY, Tay JY, Cutter JL, Ng DHL. The yield of tuberculosis contact investigation on relapsed TB patients and analysis of associated risk factors: Singapore's experience. Epidemiol Infect 2024; 152:e26. [PMID: 38229514 PMCID: PMC10894891 DOI: 10.1017/s0950268824000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
The yield of contact investigation on relapsed tuberculosis (TB) cases can guide strategies and resource allocation in the TB control programme. We conducted a retrospective cohort study to review the yield of contact investigation in relapsed TB cases and identify factors associated with TB infection (TBI) among close contacts of relapsed TB cases notified between 2018 and 2022 in Singapore. TB infection positivity was higher among contacts of relapsed cases which were culture-positive for Mycobacterium tuberculosis complex compared to those who were only polymerase chain reaction (PCR)-positive (14.8% vs. 12.3%). On multivariate analysis, after adjusting for age and gender of the index, gender, and existing comorbidities of contacts, factors independently associated with TBI were culture and smear positivity of the index (AOR 1.41, 95%CI 1.02-1.94), higher odds with every 10 years of increase in age compared to contacts below aged 30, contacts who were not Singapore residents (AOR 2.09, 95%CI 1.46-2.97), and household contacts (AOR 2.19, 95%CI 1.44-3.34). Although the yield of screening was higher for those who were culture-positive compared to only PCR-positive relapsed cases, contact tracing for only PCR-positive cases may still be important in a country with moderate TB incidence, should resources allow.
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Mahajan P, Soundappan K, Singla N, Mehta K, Nuken A, Thekkur P, Nair D, Rattan S, Thakur C, Sachdeva KS, Kalottee B. Test and Treat Model for Tuberculosis Preventive Treatment among Household Contacts of Pulmonary Tuberculosis Patients in Selected Districts of Maharashtra: A Mixed-Methods Study on Care Cascade, Timeliness, and Early Implementation Challenges. Trop Med Infect Dis 2023; 9:7. [PMID: 38251204 PMCID: PMC10818418 DOI: 10.3390/tropicalmed9010007] [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: 10/30/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Tuberculosis preventive treatment (TPT) is an important intervention in preventing infection and reducing TB incidence among household contacts (HHCs). A mixed-methods study was conducted to assess the "Test and Treat" model of TPT care cascade among HHCs aged ≥5 years of pulmonary tuberculosis (PTB) patients (bacteriologically/clinically confirmed) being provided TPT care under Project Axshya Plus implemented in Maharashtra (India). A quantitative phase cohort study based on record review and qualitative interviews to understand the challenges and solutions in the TPT care cascade were used. Of the total 4181 index patients, 14,172 HHCs were screened, of whom 36 (0.3%) HHCs were diagnosed with tuberculosis. Among 14,133 eligible HHCs, 10,777 (76.3%) underwent an IGRA test. Of them, 2468 (22.9%) tested positive for IGRA and were suggested for chest X-ray. Of the eligible 2353 HHCs, 2159 (91.7%) were started on TPT, of whom 1958 (90.6%) completed the treatment. The median time between treatment initiation of index PTB patient and (a) HHC screening was 31 days; (b) TPT initiation was 64 days. The challenges in and suggested solutions for improving the TPT care cascade linked to subthemes were tuberculosis infection testing, chest X-ray, human resources, awareness and engagement, accessibility to healthcare facilities, TPT drugs, follow-up, and assessment. A systematic monitoring and time-based evaluation of TPT cascade care delivery followed by prompt corrective actions/interventions could be a crucial strategy for its effective implementation and for the prevention of tuberculosis.
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Affiliation(s)
- Palak Mahajan
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Kathirvel Soundappan
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Neeta Singla
- National Institute of TB & Respiratory Disease, New Delhi 110030, India;
| | - Kedar Mehta
- Department of Community Medicine, Gujarat Medical Education & Search Society Medical College, Vadodara 390021, India;
| | - Amenla Nuken
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (P.T.); (D.N.)
| | - Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (P.T.); (D.N.)
| | - Sampan Rattan
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Chaturanand Thakur
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Kuldeep Singh Sachdeva
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Bharati Kalottee
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
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Kadyrov M, Thekkur P, Geliukh E, Sargsyan A, Goncharova O, Kulzhabaeva A, Kadyrov A, Khogali M, Harries AD, Kadyrov A. Contact Tracing and Tuberculosis Preventive Therapy for Household Child Contacts of Pulmonary Tuberculosis Patients in the Kyrgyz Republic: How Well Are We Doing? Trop Med Infect Dis 2023; 8:332. [PMID: 37505628 PMCID: PMC10386269 DOI: 10.3390/tropicalmed8070332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Early identification, screening and investigation for tuberculosis (TB), and provision of TB preventive therapy (TPT), reduces risk of TB among child household contacts of pulmonary TB patients (index patients). A cohort study was conducted to describe the care cascade and timeliness of contact tracing and TPT initiation among child household contacts (aged < 15 years) of index patients initiated on TB treatment in Bishkek, the Kyrgyz Republic during October 2021-September 2022. In the register, information on the number of child household contacts was available for 153 (18%) of 873 index patients. Of 297 child household contacts identified, data were available for 285, of whom 261 (92%) were screened for TB. More than 50% were screened after 1 month of the index patient initiating TB treatment. TB was diagnosed in 23/285 (9%, 95% CI: 6-13%) children. Of 238 TB-free children, 130 (55%) were eligible for TPT. Of the latter, 64 (49%) were initiated on TPT, of whom 52 (81%) completed TPT. While TPT completion was excellent, there was deficiency in contact identification, timely screening and TPT initiation. Thus, healthcare providers should diligently request and record details of child household contacts, adhere to contact tracing timelines and counsel caregivers regarding TPT.
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Affiliation(s)
- Meder Kadyrov
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
| | - Evgenia Geliukh
- International Charitable Foundation "Alliance for Public Health", 01601 Kiev, Ukraine
| | - Aelita Sargsyan
- Tuberculosis Research and Prevention Centre (TBRPC), Yerevan 0014, Armenia
| | - Olga Goncharova
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
| | | | - Asel Kadyrov
- Primary Healthcare Centre #1, Bishkek 720000, Kyrgyzstan
| | - Mohammed Khogali
- Institute of Public Health (IPH), College of Medicine and health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 15551, United Arab Emirates
| | - Anthony D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Abdullaat Kadyrov
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
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Buonsenso D, Seddon JA, Esposito S, Barcellini L. QuantiFERON-TB Gold Plus Performance in Children: A Narrative Review. Pediatr Infect Dis J 2023; 42:e158-e165. [PMID: 36795574 PMCID: PMC10097492 DOI: 10.1097/inf.0000000000003877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 02/17/2023]
Abstract
This review summarizes studies evaluating the performance of the QuantiFERON-TB Gold Plus (QFT-Plus) interferon-gamma release assay (IGRA) test for Mycobacterium tuberculosis ( Mtb ) infection in children. Literature searching was conducted using PubMed, MEDLINE and Embase (January 2017 to December 2021) and the terms "children" or "pediatric" and "IGRAs" or "QuantiFERON-TB Gold Plus." Selected studies (N = 14; 4646 subjects) enrolled children with Mtb infection, tuberculosis (TB) disease or healthy children with household TB contacts. Agreement between QFT-Plus and tuberculin skin test (TST) (kappa values) ranged from -0.201 (no agreement) to 0.83 (almost perfect agreement). Assay sensitivity of QFT-Plus (against reference standard of microbiologically confirmed TB disease) was 54.5%-87.3%, with no reported difference in children less than 5 versus greater than or equal to 5 years of age. In individuals less than or equal to 18 years of age, the rate of indeterminate results was 0%-33.3% (2.6% in children <2 years). IGRAs may overcome the limitations of TST in young, Bacillus Calmette-Guérin-vaccinated children.
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Affiliation(s)
- Danilo Buonsenso
- From the Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Global Health Research Institute, Università Cattolica del Sacro Cuore, Rome, Italy
| | - James A. Seddon
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Susanna Esposito
- Pietro Barilla Children’s Hospital, Pediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Lucia Barcellini
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
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Miotto P, Goletti D, Petrone L. Making IGRA testing easier: First performance report of QIAreach QFT for tuberculosis infection diagnosis. Pulmonology 2021; 28:4-5. [PMID: 34756692 DOI: 10.1016/j.pulmoe.2021.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- P Miotto
- Emerging Bacterial Pathogens Unit, Div. of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - D Goletti
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - L Petrone
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Rome, Italy
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