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Asare-Baah M, Salmon-Trejo LAT, Venkatappa T, Garfein RS, Aiona K, Haas M, Séraphin MN. Factors Associated With the Discontinuation of Two Short-Course Tuberculosis Preventive Therapies in Programmatic Settings in the United States. Open Forum Infect Dis 2024; 11:ofae313. [PMID: 38915338 PMCID: PMC11194754 DOI: 10.1093/ofid/ofae313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
Background The objective of this study was to investigate timing and risk factors for discontinuation of short-course tuberculosis preventive therapy (TPT) comparing directly observed 3-month isoniazid/rifapentine (3HP) vs self-administered 4-month rifampin (4R). Methods This was a subanalysis of a 6-month health department cohort (2016-2017) of 993 latent tuberculosis infection (LTBI) patients initiating 3HP (20%) or 4R (80%). Time at risk of TPT discontinuation was compared across regimens. Risk factors were assessed using mixed-effects Cox models. Results Short-course TPT discontinuation was higher with 4R (31% vs 14%; P < .0001), though discontinuation timing was similar. Latino ethnicity (hazard ratio [HR], 1.80; 95% CI, 1.20-2.90) and adverse events (HR, 4.30; 95% CI, 2.60-7.30) increased 3HP discontinuation risk. Social-behavioral factors such as substance misuse (HR, 12.00; 95% CI, 2.20-69.00) and congregate living (HR, 21.00; 95% CI, 1.20-360.00) increased 4R discontinuation risk. Conclusions TPT discontinuation differed by regimen, with distinct risk factors. Addressing social determinants of health within TPT programs is critical to enhance completion rates and reduce TB disease risk in marginalized populations.
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Affiliation(s)
- Michael Asare-Baah
- Department of Epidemiology, University of Florida, Gainsville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainsville, Florida, USA
| | - LaTweika A T Salmon-Trejo
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida, Gainsville, Florida, USA
- Institute of Public Health, Florida A & M University, Tallahassee, Florida, USA
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thara Venkatappa
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard S Garfein
- Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - Kaylynn Aiona
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Michelle Haas
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado, USA
| | - Marie Nancy Séraphin
- Emerging Pathogens Institute, University of Florida, Gainsville, Florida, USA
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida, Gainsville, Florida, USA
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Getachew RG, Tolossa T, Teklemariam Z, Ayele A, Roba HS. Incidence and predictors of treatment interruption among patients on anti-tuberculosis treatment in Nekemte public healthcare facilities, Oromia, Western Ethiopia. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1234865. [PMID: 38455888 PMCID: PMC10910942 DOI: 10.3389/fepid.2023.1234865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024]
Abstract
Introduction Tuberculosis treatment interruption increases the risk of poor treatment outcomes and the occurrence of drug resistant Tuberculosis. However, data on the incidence and predictors of tuberculosis treatment interruption are still scarce in Ethiopia, as well as in the study area. Therefore, this study aimed to assess the incidence and predictors of treatment interruption among patients on tuberculosis treatment in Nekemte public healthcare facilities, Oromia region, Western Ethiopia, from July 1, 2017, to June 30, 2021. Methods A retrospective cohort study design was conducted among 800 patients enrolled in anti-tuberculosis treatment during the study period. Data were collected from patient cards who were enrolled in treatment from July 1, 2017 to June 30, 2021. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A multivariable Cox regression model with a 95% confidence interval (CI) and adjusted hazard ratio (AHR) was used to identify the significant predictors at a p value < 0.05. Finally, the log likelihood ratio, and a Cox-Snell residual graph was used to check the adequacy of the model. Results A total of 800 patients were followed for a median time of 2.3 (95% CI: 2.20-2.36) months, and with a maximum follow-up time of 11.7 months. The overall incidence rate of treatment interruption was 27.4 per 1000 (95% CI: 22.8-32.8) person-month observations. Age 18-34 years (AHR = 1.8, 95% CI: 1.02-3.18), male (AHR = 1.63, 95% CI: 1.1-2.42), rural residence (AHR = 3, 95% CI: 1.98-4.64), presence of comorbidity (AHR = 10, 95% CI: 5.47-18.27) and lack of treatment supporters on the treatment follow-up (AHR = 2.82, 95% CI: 1.9-4.41) were found to be significant predictors of treatment interruption. Conclusion A high incidence rate of interruption was observed among TB patients in public health facilities in Nekemte town. Health facilities should provide supportive care for patients with co-morbidities and consider interventions that target middle-aged patients from rural areas that reduce treatment interruptions.
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Affiliation(s)
- Robsan Gudeta Getachew
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Zelalem Teklemariam
- School of Medical Laboratory Sciences, College Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Angefa Ayele
- School of Public Health, Institute of Health Sciences, Bule Hora University, Bule Hora, Ethiopia
| | - Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, QLD, Australia
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Séraphin MN, Bellot J, Klann E, Ukhanova M, Saulsberry FG, Peloquin CA, Mai V. Gut microbiota composition and diversity before, during, and two months after rifamycin-based tuberculosis preventive therapy. Sci Rep 2023; 13:18933. [PMID: 37919333 PMCID: PMC10622450 DOI: 10.1038/s41598-023-44854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/12/2023] [Indexed: 11/04/2023] Open
Abstract
Tuberculosis (TB) preventive therapy (TPT) is an effective strategy to eliminate TB in low-incidence settings. Shorter TPT regimens incorporating the antimicrobial class of rifamycins are designed to improve adherence and completion rates but carry the risk of modifications to the gut microbiota. We enrolled six subjects diagnosed with latent TB infection (LTBI) who accepted to initiate TPT. We also enrolled six healthy volunteers unexposed to the rifamycins. We profiled the gut microbiota using 16S rRNA amplicon sequencing (V1-V2 region) to document the immediate effect of rifamycin-based TPT on the gut microbiota composition and tracked recovery to baseline two months after TPT. Overall, TPT accounted for 17% of the variance in gut microbial community dissimilarity. This rifamycin-based TPT induced dysbiosis was characterized by a depletion of butyrate-producing taxa (Clostridium-XIVa and Roseburia) and expansion of potentially pathogenic taxa within the Firmicutes and Proteobacteria phyla. Recovery of the gut microbial composition was incomplete two months after TPT. Robust clinical studies are necessary to comprehensively catalogue TPT-induced gut microbiota dysbiosis to inform strategies to mitigate potential long-term sequelae of this important TB control intervention.
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Affiliation(s)
- Marie Nancy Séraphin
- Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
| | - Julia Bellot
- Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Emily Klann
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Maria Ukhanova
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Florence G Saulsberry
- Florida Department of Health in Alachua County, Disease Control Unit, Alachua County Health Department, Gainesville, FL, USA
| | - Charles A Peloquin
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Infectious Disease Pharmacokinetics Laboratory, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Volker Mai
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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Kasuya S, Imai A, Uchimura K, Ohkado A, Kawatsu L. Epidemiology of latent tuberculosis infection in Japan-born and foreign-born children in Japan. Western Pac Surveill Response J 2023; 14:1-7. [PMID: 38230255 PMCID: PMC10789721 DOI: 10.5365/wpsar.2023.14.4.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Objective This study aims to compare the epidemiology of notifications of latent tuberculosis infection (LTBI) among Japan-born and foreign-born children in Japan between 2010 and 2020, and to assess the language used during LTBI case interviews with parents or caregivers of foreign-born children with LTBI during 2019. Methods Our study consisted of two parts: (1) an analysis of national data from the Japan Tuberculosis Surveillance (JTBS) system on the epidemiology of LTBI among Japan-born and foreign-born children in Japan, and (2) a survey of staff at public health centres that had registered at least one foreign-born child aged ≤ 14 years with LTBI. Data were extracted from the JTBS system for all children aged ≤ 14 years who were newly notified as having LTBI between 2010 and 2020, and analysed to determine trends, characteristics and treatment outcomes. Staff at relevant public health centres completed a self-administered survey. Results A total of 7160 Japan-born and 320 foreign-born children were notified as having LTBI between 2010 and 2020. Compared with Japan-born children, foreign-born children notified as having LTBI were more likely to be older, have their mother or sibling as their source of infection and have LTBI detected via a routine school health check. At case interviews, the use of language interpretation services was limited, even when both parents were non-Japanese. No interview was directly conducted with children themselves, not even with school-aged children. Discussion Foreign-born children and their parents may be unfamiliar with the system of testing for TB infection and the diagnosis of LTBI in Japan in school settings. Public health centres are required to provide education to patients and their families and care that takes into account cultural and linguistic differences. However, the provision of language support during case interviews may need strengthening.
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Affiliation(s)
- Saori Kasuya
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Akiko Imai
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kazuhiro Uchimura
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Lisa Kawatsu
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
- Nagoya City University, Aichi, Japan
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Chiu TF, Yen MY, Shie YH, Huang HL, Chen CC, Yen YF. Determinants of latent tuberculosis infection and treatment interruption in long-term care facilities: A retrospective cohort study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1310-1317. [PMID: 34686442 DOI: 10.1016/j.jmii.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND/PURPOSE Latent tuberculosis infection (LTBI) treatment is challenging in long-term care facilities (LTCFs) residents due to the occurrence of medical complexities. However, factors associated with treatment interruption have not been extensively studied. This retrospective cohort study aimed to determine LTBI-associated factors and treatment interruption in LTCF residents and employees in Taiwan. METHODS From May 2017 through September 2020, the residents and employees of 20 LTCFs in Taipei, Taiwan, were screened for LTBI by using QuantiFERON-TB Gold In-Tube test. The LTBI individuals underwent directly observed preventive therapy (DOPT), including regimens of 9-month daily isoniazid (9H) and 3-month weekly isoniazid plus rifapentine (3HP). All the LTBI cases were followed up till treatment completion, death, or treatment interruption. RESULTS Among 2207 LTCF subjects, 16.8% had LTBI. After controlling for other covariates, residents of public facilities had a significantly higher LTBI prevalence than those of private facilities (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI]: 1.08-1.88). Among 264 LTBI cases receiving preventive therapy, 52 (19.7%) had treatment interruption. LTBI cases receiving 3HP were less likely to have treatment interruption than those receiving 9H (AOR = 0.22; 95% CI: 0.07-0.71). CONCLUSIONS LTCF residents, particular those living in public facilities, had a high LTBI prevalence. 3HP with DOPT is considered the priority regimen for preventive therapy among LTBI cases in LTCFs.
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Affiliation(s)
- Ting-Fang Chiu
- Department of Education and Research, Taipei City Hospital, Taiwan; Department of Pediatrics, Taipei City Hospital, Zhongxiao Branch, Taiwan; University of Taipei, Taipei, Taiwan
| | - Muh-Yong Yen
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan; Division of Infectious Diseases, Cheng Hsin General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Huei Shie
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
| | - Hui-Lan Huang
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Education and Research, Taipei City Hospital, Taiwan; University of Taipei, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Güner AE, Kiziltas S, Babalik A, Sahin E, Sibel A, Safak M, Kiliçaslan Z. Outcomes of latent tuberculosis infection treatment in Istanbul. Int J Mycobacteriol 2022; 11:442-447. [PMID: 36510932 DOI: 10.4103/ijmy.ijmy_196_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Aim Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in İstanbul between 2016 and 2018. Methods The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. Results 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). Conclusion In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.
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Affiliation(s)
- Abdullah Emre Güner
- Department of Public Health, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey
| | - Sule Kiziltas
- Department of Chest Diseases, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Aylin Babalik
- Department of Chest Diseases, University of Health Sciences, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Esra Sahin
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Al Sibel
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Mine Safak
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Zeki Kiliçaslan
- Department of Chest Diseases, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Shahid NUA, Naguit N, Jakkoju R, Laeeq S, Reghefaoui T, Zahoor H, Yook JH, Rizwan M, Mohammed L. Use of Isoniazid Monotherapy in Comparison to Rifamycin-Based Regimen for the Treatment of Patients With Latent Tuberculosis: A Systematic Review. Cureus 2022; 14:e25083. [PMID: 35733481 PMCID: PMC9205649 DOI: 10.7759/cureus.25083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) is a common infectious disease that is present all around the world. This insidious disease needs drastic measures for its eradication. One of the actions contributing to it is the timely diagnosis and offering suitable treatment options for latent tuberculosis patients. In this review, we will discuss and compare the variety of options available for this purpose. We searched PubMed/Medline, Cochrane library, Google Scholar, and Science Direct to find articles regarding the effectiveness, safety, and completion of any of the five regimens available for latent tuberculosis infection. These options are the most classic and standard nine months of isoniazid given daily, which is now more commonly given as six months course, three months of daily isoniazid and rifampin, three months of weekly isoniazid and rifapentine, and four months of daily rifampin. We looked into free full-text studies published from 2011 to 2021 available in English language and human studies. After applying inclusion/exclusion criteria and removing duplicates and screening, 34 articles were shortlisted for quality assessment check, after which we finalized nine studies. Cochrane risk-of-bias assessment tool was used for quality check of randomized control trials, New-Castle Ottawa tool for observational studies, and assessment of multiple systematic reviews (AMSTAR) tool for systematic reviews. Efficacy was checked by tracking down the new cases of TB in the sample population that took the treatment for latent tuberculosis infection. New rifamycin-based regimens were almost equal in effectiveness to isoniazid regimens. The side effect profile is different for both regimens, but short-duration courses tend to have a higher chance of completion.
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Khabibullina NF, Kutuzova DM, Burmistrova IA, Lyadova IV. The Biological and Clinical Aspects of a Latent Tuberculosis Infection. Trop Med Infect Dis 2022; 7:tropicalmed7030048. [PMID: 35324595 PMCID: PMC8955876 DOI: 10.3390/tropicalmed7030048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 01/22/2023] Open
Abstract
Tuberculosis (TB), caused by bacilli from the Mycobacterium tuberculosis complex, remains a serious global public health problem, representing one of the main causes of death from infectious diseases. About one quarter of the world’s population is infected with Mtb and has a latent TB infection (LTBI). According to the World Health Organization (WHO), an LTBI is characterized by a lasting immune response to Mtb antigens without any TB symptoms. Current LTBI diagnoses and treatments are based on this simplified definition, although an LTBI involves a broad range of conditions, including when Mtb remains in the body in a persistent form and the immune response cannot be detected. The study of LTBIs has progressed in recent years; however, many biological and medical aspects of an LTBI are still under discussion. This review focuses on an LTBI as a broad spectrum of states, both of the human body, and of Mtb cells. The problems of phenotypic insusceptibility, diagnoses, chemoprophylaxis, and the necessity of treatment are discussed. We emphasize the complexity of an LTBI diagnosis and its treatment due to its ambiguous nature. We consider alternative ways of differentiating an LTBI from active TB, as well as predicting TB reactivation based on using mycobacterial “latency antigens” for interferon gamma release assay (IGRA) tests and the transcriptomic analysis of human blood cells.
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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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Ignatius EH, Swindells S. Are We There Yet? Short-Course Regimens in TB and HIV: From Prevention to Treatment of Latent to XDR TB. Curr HIV/AIDS Rep 2020; 17:589-600. [PMID: 32918195 PMCID: PMC9178518 DOI: 10.1007/s11904-020-00529-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Despite broad uptake of antiretroviral therapy (ART), tuberculosis (TB) incidence and mortality among people with HIV remain unacceptably high. Short-course regimens for TB, incorporating both novel and established drugs, offer the potential to enhance adherence and completion rates, thereby reducing the global TB burden. This review will outline short-course regimens for TB among patients with HIV. RECENT FINDINGS After many years without new agents, there is now active testing of many novel drugs to treat TB, both for latent infection and active disease. Though not all studies have included patients with HIV, many have, and there are ongoing trials to address key implementation challenges such as potent drug-drug interactions with ART. The goal of short-course regimens for TB is to enhance treatment completion without compromising efficacy. Particularly among patients with HIV, studying these shortened regimens and integrating them into clinical care are of urgent importance. There are now multiple short-course regimens for latent infection and active disease that are safe and effective among patients with HIV.
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Affiliation(s)
- Elisa H Ignatius
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Susan Swindells
- University of Nebraska Medical Center, Omaha, NE, 68198-8106, USA.
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