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Bhargava A, Bhargava M, Pai M. Tuberculosis: a biosocial problem that requires biosocial solutions. Lancet 2024; 403:2467-2469. [PMID: 38521083 DOI: 10.1016/s0140-6736(24)00489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Anurag Bhargava
- Department of Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Madhukar Pai
- McGill School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, Canada.
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Munedzimwe F, Chetty-Makkan CM, Mukora R, Charalambous S, Turner K, Chihota V. "It's about time they taught us": a qualitative study evaluating the barriers to finding and screening child contacts under five at risk for TB in Gauteng Province, South Africa from the provider and caregiver perspectives. BMC Health Serv Res 2023; 23:1415. [PMID: 38102646 PMCID: PMC10722712 DOI: 10.1186/s12913-023-10359-0] [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] [Received: 05/04/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Inadequate numbers of children under five years of age who are exposed to tuberculosis (TB) in the home (child contact) are initiated on TB preventive treatment (TPT) in South Africa. We assessed barriers of initiating isoniazid preventive therapy (IPT) in this age group. METHODS We conducted a qualitative study at two primary health clinics in the Ekurhuleni district in Gauteng Province. Between April and July 2019, we enrolled facility managers, TB staff and parents or legal guardians of child contacts (caregivers) attending for care, at the two facilities. Semi-structured questionnaires, facility observations and in-depth interviews using a semi-structured interview guide were used to collect data. Findings from the semi-structured questionnaires with facility staff and facility observations were summarized. Thematic analysis with a deductive approach was used to analyse the data from the in-depth interviews with caregivers. RESULTS Two facility managers took part in the study and were assisted to complete the semi-structured questionnaires by TB staff. Fifteen caregivers aged between 18 and 43 years were interviewed of which 13 (87%) were female. Facility managers and TB staff (facility staff) felt that even though caregivers knew of family members who were on TB treatment, they delayed bringing their children for TB screening and TPT. Facility staff perceived caregivers as not understanding the purpose and benefits of TB prevention strategies such as TPT. Caregivers expressed the desire for their children to be screened for TB. However, caregivers lacked knowledge on TB transmission and the value of TB prevention in children at high risk of infection. CONCLUSION While facility staff perceived caregivers to lack responsibility, caregivers expressed limited knowledge on the value of screening their children for TB as reasons for not accessing TB preventive services. Health education on TB transmission, screening, and TB prevention strategies at a community level, clinics, creches, schools and via media are important to achieve the global end TB goal of early detection and prevention of TB.
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Affiliation(s)
- Fadzai Munedzimwe
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - C M Chetty-Makkan
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Mukora
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - S Charalambous
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Yale University, New Haven, Connecticut, USA
| | - K Turner
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - V Chihota
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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Bonnet M, Vasiliu A, Tchounga BK, Cuer B, Fielding K, Ssekyanzi B, Tchakounte Youngui B, Cohn J, Dodd PJ, Tiendrebeogo G, Tchendjou P, Simo L, Okello RF, Kuate Kuate A, Turyahabwe S, Atwine D, Graham SM, Casenghi M. Effectiveness of a community-based approach for the investigation and management of children with household tuberculosis contact in Cameroon and Uganda: a cluster-randomised trial. Lancet Glob Health 2023; 11:e1911-e1921. [PMID: 37918417 DOI: 10.1016/s2214-109x(23)00430-8] [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: 03/13/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Globally, the uptake of tuberculosis-preventive treatment (TPT) among children with household tuberculosis contact remains low, partly due to the necessity of bringing children to health facilities for investigations. This study aimed to evaluate the effect on TPT initiation and completion of community-based approaches to tuberculosis contact investigations in Cameroon and Uganda. METHODS We did a parallel, cluster-randomised, controlled trial across 20 clusters (consisting of 25 district hospitals and primary health centres) in Cameroon and Uganda, which were randomised (1:1) to receive a community-based approach (intervention group) or standard-of-care facility-based approach to contact screening and management (control group). The community-based approach consisted of symptom-based tuberculosis screening of all household contacts by community health workers at the household, with referral of symptomatic contacts to local facilities for investigations. Initiation of TPT (3-month course of rifampicin-isoniazid) was done by a nurse in the household, and home visits for TPT follow-up were done by community health workers. Index patients were people aged 15 years or older with bacteriologically confirmed, drug-susceptible, pulmonary tuberculosis diagnosed less than 1 month before inclusion and who declared at least one child or young adolescent (aged 0-14 years) household contact. The primary endpoint was the proportion of declared child contacts in the TPT target group (those aged <5 years irrespective of HIV status, and children aged 5-14 years living with HIV) who commenced and completed TPT, assessed in the modified intention-to-treat population (excluding enrolled index patients and their contacts who did not fit the eligibility criteria). Descriptive cascade of care assessment and generalised linear mixed modelling were used for comparison. This study is registered with ClinicalTrials.gov (NCT03832023). FINDINGS The study included nine clusters in the intervention group (after excluding one cluster that did not enrol any index patients for >2 months) and ten in the control group. Between Oct 14, 2019 and Jan 13, 2022, 2894 child contacts were declared by 899 index patients with bacteriologically confirmed tuberculosis. Among all child contacts declared, 1548 (81·9%) of 1889 in the intervention group and 475 (47·3%) of 1005 in the control group were screened for tuberculosis. 1400 (48·4%) child contacts were considered to be in the TPT target group: 941 (49·8%) of 1889 in the intervention group and 459 (45·7%) of 1005 in the control group. In the TPT target group, TPT was commenced and completed in 752 (79·9%) of 941 child contacts in the intervention group and 283 (61·7%) of 459 in the control group (odds ratio 3·06 [95% CI 1·24-7·53]). INTERPRETATION A community-based approach using community health workers can significantly increase contact investigation coverage and TPT completion among eligible child contacts in a tuberculosis-endemic setting. FUNDING Unitaid. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Maryline Bonnet
- TransVIHMI, University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France.
| | - Anca Vasiliu
- TransVIHMI, University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Benjamin Cuer
- TransVIHMI, University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | | | | | | | - Jennifer Cohn
- Department of Innovation and New Technology, Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Georges Tiendrebeogo
- University Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | | | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | | | | | - Daniel Atwine
- Clinical Research Department, Epicentre Mbarara Research Centre, Mbarara, Uganda
| | - Stephen M Graham
- Royal Children's Hospital, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Melbourne, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Martina Casenghi
- Department of Innovation and New Technology, Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
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van Crevel R, Hill PC. Shorter regimens for tuberculosis preventive treatment: piecing together the global implementation jigsaw. THE LANCET. RESPIRATORY MEDICINE 2023; 11:757-759. [PMID: 36966789 DOI: 10.1016/s2213-2600(23)00086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, Netherlands; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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An Y, Teo AKJ, Huot CY, Tieng S, Khun KE, Pheng SH, Leng C, Deng S, Song N, Nonaka D, Yi S. They do not have symptoms - why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study. BMC Pulm Med 2023; 23:83. [PMID: 36899328 PMCID: PMC10000356 DOI: 10.1186/s12890-023-02379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Latent tuberculosis (TB) infection has been known as a seedbed for TB disease later in life. The interruption from latent TB infection to TB disease can be done through TB preventive treatment (TPT). In Cambodia, only 40.0% of children under five years old who were the household contacts to bacteriologically confirmed TB cases were initiated with TPT in 2021. Scientific studies of context-specific operational challenges in TPT provision and uptake among children are scarce, particularly in high TB-burden countries. This study identified challenges in TPT provision and uptake among children in Cambodia from the perspective of healthcare providers and caregivers. METHODS Between October and December 2020, we conducted in-depth interviews with four operational district TB supervisors, four clinicians and four nurses in charge of TB in referral hospitals, four nurses in charge of TB in health centers, and 28 caregivers with children currently or previously on TB treatment or TPT, and those who refused TPT for their eligible children. Data were audio recorded along with field notetaking. After verbatim transcription, data analyses were performed using a thematic approach. RESULTS The mean age of healthcare providers and caregivers were 40.19 years (SD 12.0) and 47.9 years (SD 14.6), respectively. Most healthcare providers (93.8%) were male, and 75.0% of caregivers were female. More than one-fourth of caregivers were grandparents, and 25.0% had no formal education. Identified key barriers to TPT implementation among children included TPT side effects, poor adherence to TPT, poor understanding of TPT among caregivers, TPT risk perception among caregivers, TPT's child-unfriendly formula, TPT supply-chain issues, caregivers' concern about the effectiveness of TPT, being non-parental caregivers, and poor community engagement. CONCLUSION Findings from this study suggest that the national TB program should provide more TPT training to healthcare providers and strengthen supply chain mechanisms to ensure adequate TPT drug supplies. Improving community awareness of TPT among caregivers should also be intensified. These context-specific interventions will play a crucial role in expanding the TPT program to interrupt the development from latent TB infection to active and ultimately lead to ending TB in the country.
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Affiliation(s)
- Yom An
- Sustaining Technical and Analytical Resources (STAR), the Public Health Institute (PHI), Phnom Penh, Cambodia. .,School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan. .,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Chan Yuda Huot
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sivanna Tieng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Kim Eam Khun
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.,National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sok Heng Pheng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Chhenglay Leng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | | | - Ngak Song
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Daisuke Nonaka
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Siyan Yi
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA
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Benoit Vásquez GI, Morrobel AL, Benjumea-Bedoya D, Del Corral-Londoño H. Barriers and facilitators for isoniazid preventive therapy (IPT) administration in children under 5 years of age in the Dominican Republic. BMC Infect Dis 2022; 22:359. [PMID: 35410136 PMCID: PMC8996516 DOI: 10.1186/s12879-022-07333-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Throughout the world tuberculosis (TB) is the second leading cause of death due to an infectious agent. The World Health Organization promotes Isoniazid Preventive Therapy (IPT) in children under 5 years who are contacts of persons diagnosed with smear-positive pulmonary TB (SPPTB). In 2019, 33% of children identified as contacts received IPT globally, while in the Americas 11 countries reached coverages ≥ 75%, only 35% did so in the Dominican Republic (DR). The aim of this study was to identify barriers and facilitators for IPT administration in children under 5 in the Area IV Directorate of Health of the DR's National District. METHODS Descriptive study, using mixed methods and sequential explanatory approach. We characterized children under 5 years who were contacts of a person with SPPTB. Later, semi-structured interviews and content analysis allowed identification of barriers and facilitators for IPT administration in children who were contacts of a person diagnosed with SPPTB, as perceived by relatives and health system personnel. RESULTS A total of 238 children were identified as contacts of 174 persons with SPPTB: 36% of these received IPT while no data on IPT administration was found for 11% of them. The proportion of children who had a tuberculin skin test (TST) done was < 20%. However, those who had the test done had a greater opportunity to receive IPT (OR: 8.12, CI 95%: 1.60-41.35). Barriers identified include socioeconomic conditions of children and families, stigma, lack of information in clinical and follow-up records, lack of coordination between public and private providers and lack of coherence within national regulations. Facilitators include home based care of persons with TB and their contacts, transfer of treatment to a health centre near household, isoniazid availability, provision of information by health-workers and economic support for food and transportation. CONCLUSIONS Incomplete data, lack of use of TST to rule out active TB, socioeconomic and cultural conditions, were barriers for IPT administration. Implementation of a person centred approach to care was found to be the main facilitator for IPT uptake. Administration of IPT depends predominantly on modifiable health system factors. This allows rapid identification of strategies to improve IPT administration.
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Affiliation(s)
- Grey Idalia Benoit Vásquez
- Administradora de Estancias Infantiles Salud Segura, Santo Domingo, Dominican Republic.
- National Directorate of Epidemiology (DIGEPI), Ministry of Public Health, Santo Domingo, Dominican Republic.
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
| | - Ana Lucia Morrobel
- Programa de Control de Tuberculosis, Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Dione Benjumea-Bedoya
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación en Salud Familiar y Comunitaria. Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia
| | - Helena Del Corral-Londoño
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de investigación MICROBA, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
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Zegarra-Chapoñan R, Bonadonna LV, Yuen CM, Martina-Chávez MB, Zeladita-Huaman J. Implementation of isoniazid preventive therapy in southern Lima, Peru: an analysis of health center characteristics. Infect Dis Poverty 2021; 10:63. [PMID: 33962691 PMCID: PMC8106215 DOI: 10.1186/s40249-021-00845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Tuberculosis (TB) prevention through the use of preventive treatment is a critical activity in the elimination of TB. In multiple settings, limited staffing has been identified as a barrier to managing preventive treatment for TB contacts. This study aims to determine how health center staffing, service type, and TB caseload affects implementation of isoniazid preventive therapy (IPT) for TB contacts in southern Lima. Methods We conducted an ecological study in 2019 in southern Lima, Peru. Through the review of medical records, we identified contacts of TB patients who initiated IPT during 2016–2018, and who were 0–19 years old, the age group eligible for IPT according to Peruvian guidelines. We assessed bivariate associations between health center characteristics (numbers of physicians and nurses, types of services available, annual TB caseload) and IPT initiation and completion using binomial logistic regression. Results Among 977 contacts, 69% took more than a week to start IPT and 41% did not complete IPT. For those who successfully completed IPT, 58% did not complete full medical follow-up. There was no significant difference in IPT completion or adherence based on whether health centers had more physicians and nurses, more comprehensive services, or higher TB caseloads. Among contacts, female sex was associated with delay in initiating IPT (P = 0.005), age 5–19 years old was associated with completion of IPT (P = 0.025) and age < 5 years old was associated with completion of clinical evaluations (P = 0.041). Conclusions There are significant gaps in IPT implementation in health centers of southern Lima, Peru, but insufficient staffing of health centers may not be responsible. Further research is needed to identify how IPT implementation can be improved, potentially through improving staff training or monitoring and supervision. Graphic abstract ![]()
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Oxlade O, Benedetti A, Adjobimey M, Alsdurf H, Anagonou S, Cook VJ, Fisher D, Fox GJ, Fregonese F, Hadisoemarto P, Hill PC, Johnston J, Khan FA, Long R, Nguyen NV, Nguyen TA, Obeng J, Ruslami R, Schwartzman K, Trajman A, Valiquette C, Menzies D. Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial. LANCET PUBLIC HEALTH 2021; 6:e272-e282. [PMID: 33765453 DOI: 10.1016/s2468-2667(20)30261-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Reaching the UN General Assembly High-Level Meeting on Tuberculosis target of providing tuberculosis preventive treatment to at least 30 million people by 2022, including 4 million children under the age of 5 years and 20 million other household contacts, will require major efforts to strengthen health systems. The aim of this study was to evaluate the effectiveness and cost-effectiveness of a health systems intervention to strengthen management for latent tuberculosis infection (LTBI) in household contacts of confirmed tuberculosis cases. METHODS ACT4 was a cluster-randomised, open-label trial involving 24 health facilities in Benin, Canada, Ghana, Indonesia, and Vietnam randomly assigned to either a three-phase intervention (LTBI programme evaluation, local decision making, and strengthening activities) or control (standard LTBI care). Tuberculin and isoniazid were provided to control and intervention sites if not routinely available. Randomisation was stratified by country and restricted to ensure balance of index patients with tuberculosis by arm and country. The primary outcome was the number of household contacts who initiated tuberculosis preventive treatment at each health facility within 4 months of the diagnosis of the index case, recorded in the first or last 6 months of our 20-month study. To ease interpretation, this number was standardised per 100 newly diagnosed index patients with tuberculosis. Analysis was by intention to treat. Masking of staff at the coordinating centre and sites was not possible; however, those analysing data were masked to assignment of intervention or control. An economic analysis of the intervention was done in parallel with the trial. ACT4 is registered at ClinicalTrials.gov, NCT02810678. FINDINGS The study was done between Aug 1, 2016, and March 31, 2019. During the first 6 months of the study the crude overall proportion of household contacts initiating tuberculosis preventive treatment out of those eligible at intervention sites was 0·21. After the implementation of programme strengthening activities, the proportion initiating tuberculosis preventive treatment increased to 0·35. Overall, the number of household contacts initiating tuberculosis preventive treatment per 100 index patients with tuberculosis increased between study phases in intervention sites (adjusted rate difference 60, 95% CI 4 to 116), while control sites showed no statistically significant change (-12, -33 to 10). There was a difference in rate differences of 72 (95% CI 10 to 134) contacts per 100 index patients with tuberculosis initiating preventive treatment associated with the intervention. The total cost for the intervention, plus LTBI clinical care per additional contact initiating treatment was estimated to be CA$1348 (range 724 to 9708). INTERPRETATION A strategy of standardised evaluation, local decision making, and implementation of health systems strengthening activities can provide a mechanism for scale-up of tuberculosis prevention, particularly in low-income and middle-income countries. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Olivia Oxlade
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Andrea Benedetti
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Mênonli Adjobimey
- Centre National Hospitalier Universitaire de Pneumo-Pthisiologie de Cotonou, Cotonou, Benin
| | - Hannah Alsdurf
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | | | - Victoria J Cook
- Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Greg J Fox
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Federica Fregonese
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Panji Hadisoemarto
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Faculty of Medicine, University of Otago, Otago, New Zealand
| | - James Johnston
- Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Faiz Ahmad Khan
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Richard Long
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Thu Anh Nguyen
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research in Vietnam, Hanoi, Vietnam
| | | | - Rovina Ruslami
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Kevin Schwartzman
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Anete Trajman
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chantal Valiquette
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Dick Menzies
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
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Vasiliu A, Eymard-Duvernay S, Tchounga B, Atwine D, de Carvalho E, Ouedraogo S, Kakinda M, Tchendjou P, Turyahabwe S, Kuate AK, Tiendrebeogo G, Dodd PJ, Graham SM, Cohn J, Casenghi M, Bonnet M. Community intervention for child tuberculosis active contact investigation and management: study protocol for a parallel cluster randomized controlled trial. Trials 2021; 22:180. [PMID: 33653385 PMCID: PMC7927252 DOI: 10.1186/s13063-021-05124-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings. Methods/design This multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5–14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm. Discussion This study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings. Trial registration ClinicalTrials.gov NCT03832023. Registered on 6 February 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05124-9.
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Affiliation(s)
- Anca Vasiliu
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Sabrina Eymard-Duvernay
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | - Elisabete de Carvalho
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Sayouba Ouedraogo
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | | | | | | | | | - Georges Tiendrebeogo
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.,International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Jennifer Cohn
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | | | - Maryline Bonnet
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France.
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10
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Li R, Nordio F, Huang CC, Contreras C, Calderon R, Yataco R, Galea JT, Zhang Z, Becerra MC, Lecca L, Murray MB. Two Clinical Prediction Tools to Improve Tuberculosis Contact Investigation. Clin Infect Dis 2020; 71:e338-e350. [PMID: 31905406 PMCID: PMC7643741 DOI: 10.1093/cid/ciz1221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Efficient contact investigation strategies are needed for the early diagnosis of tuberculosis (TB) disease and treatment of latent TB infections. METHODS Between September 2009 and August 2012, we conducted a prospective cohort study in Lima, Peru, in which we enrolled and followed 14 044 household contacts of adults with pulmonary TB. We used information from a subset of this cohort to derive 2 clinical prediction tools that identify contacts of TB patients at elevated risk of progressing to active disease by training multivariable models that predict (1) coprevalent TB among all household contacts and (2) 1-year incident TB among adult contacts. We validated the models in a geographically distinct subcohort and compared the relative utilities of clinical decisions based on these tools to existing strategies. RESULTS In our cohort, 296 (2.1%) household contacts had coprevalent TB and 145 (1.9%) adult contacts developed incident TB within 1 year of index patient diagnosis. We predicted coprevalent disease using information that could be readily obtained at the time an index patient was diagnosed and predicted 1-year incident TB by including additional contact-specific characteristics. The area under the receiver operating characteristic curves for coprevalent TB and incident TB were 0.86 (95% confidence interval [CI], .83-.89]) and 0.72 (95% CI, .67-.77), respectively. These clinical tools give 5%-10% higher relative utilities than existing methods. CONCLUSIONS We present 2 tools that identify household contacts at high risk for TB disease based on reportable information from patient and contacts alone. The performance of these tools is comparable to biomarkers that are both more costly and less feasible than this approach.
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Affiliation(s)
- Ruoran Li
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Francesco Nordio
- TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Chuan-Chin Huang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | | | - Jerome T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zibiao Zhang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonid Lecca
- Socios En Salud, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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11
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Contact Screening and Isoniazid Preventive Therapy Initiation for Under-Five Children among Pulmonary Tuberculosis-Positive Patients in Bahir Dar Special Zone, Northwest Ethiopia: A Cross-Sectional Study. Tuberc Res Treat 2020; 2020:6734675. [PMID: 32566291 PMCID: PMC7294357 DOI: 10.1155/2020/6734675] [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: 02/19/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/26/2022] Open
Abstract
Background Children are highly susceptible to Mycobacterium tuberculosis infection, and about 70% of children living in the same households with pulmonary tuberculosis-positive patients will become infected. However, pulmonary positive tuberculosis is a common phenomenon and the implementation of the recommended contact screening and initiation of isoniazid preventive therapy is very low. Therefore, this study is aimed at assessing contact screening practice and initiation of isoniazid preventive therapy of under-five children among pulmonary tuberculosis-positive patients in Bahir Dar, northwest Ethiopia. Methods A facility-based cross-sectional study was conducted from March 1 to 30, 2016. A total of 267 pulmonary tuberculosis-positive patients were included in this study. To identify independent predictors of contact screening and isoniazid preventive therapy initiation, we performed multivariable logistic regression analyses using SPSS version 20 with CI of 95% at p value < 0.05. Results A total of 230 (90.2%) pulmonary tuberculosis-positive patients had single contacts with their under-five children. One hundred nine (64.8%) children were screened. From those screened, 11 (7.4%) developed tuberculosis disease and started antituberculosis treatment. Forty-four (31.9%) children started isoniazid preventive therapy. Sex of the participants, place of service delivery, relationship with contacts, HIV status, and attitude of PTB+ cases were significant predictors of contact screening (p < .05). Participant's knowledge, attitude of participants, and relationship of the child with participant were significant predictors of isoniazid preventive therapy initiation (p < 0.05). Conclusion Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Intimate family contact with pulmonary tuberculosis-positive patients, place of service delivery, and attitude towards screening are the key factors of contact screening. Participant's knowledge, attitude of participants, and relationship of the child with participant are the key factors of isoniazid preventive therapy initiation. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission.
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12
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Hirsch-Moverman Y, Mantell JE, Lebelo L, Howard AA, Hesseling AC, Nachman S, Frederix K, Maama LB, El-Sadr WM. Provider attitudes about childhood tuberculosis prevention in Lesotho: a qualitative study. BMC Health Serv Res 2020; 20:461. [PMID: 32450858 PMCID: PMC7249694 DOI: 10.1186/s12913-020-05324-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The World Health Organization estimated that 1.12 million children developed tuberculosis (TB) in 2018, and at least 200,000 children died from TB. Implementation of effective child contact management is an important strategy to prevent childhood TB but these practices often are not prioritized or implemented, particularly in low- and middle-income countries. This study aimed to explore attitudes of healthcare providers toward TB prevention and perceived facilitators and challenges to child contact management in Lesotho, a high TB burden country. Qualitative data were collected via group and individual in-depth interviews with 12 healthcare providers at five health facilities in one district and analyzed using a thematic framework. RESULTS Healthcare providers in our study were interested and committed to improve child TB contact management and identified facilitators and challenges to a successful childhood TB prevention program. Facilitators included: provider understanding of the importance of TB prevention and enhanced provider training on child TB contact management, with a particular focus on ruling out TB in children and addressing side effects. Challenges identified by providers were at multiple levels -- structural, clinic, and individual and included: [1] access to care, [2] supply-chain issues, [3] identification and screening of child contacts, and [4] adherence to isoniazid preventive therapy. CONCLUSIONS Given the significant burden of TB morbidity and mortality in young children and the recent requirement by the WHO to report IPT initiation in child contacts, prioritization of child TB contact management is imperative and should include enhanced provider training on childhood TB and mentorship as well as strategies to eliminate challenges. Strategies that enable more efficient child TB contact management delivery include creating standardized tools that facilitate the implementation, tracking, and monitoring of child TB contact management coupled with guidance and mentorship from the district health management team. To tackle access to care challenges, we propose delivering intensive community health education, conducting community screening more efficiently using standardized tools, and facilitating access to services in the community.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
| | - Joanne E. Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, at the New York State Psychiatric Institute and Columbia University Irving Medical Center, Department of Psychiatry, New York, NY USA
| | - Limakatso Lebelo
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
| | - Andrea A. Howard
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
| | - Anneke C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Sharon Nachman
- Pediatric Infectious Diseases, SUNY Stony Brook, Stony Brook, NY USA
| | - Koen Frederix
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
| | | | - Wafaa M. El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
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13
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Seddon JA, Wilkinson R, van Crevel R, Figaji A, Thwaites GE. Knowledge gaps and research priorities in tuberculous meningitis. Wellcome Open Res 2019; 4:188. [PMID: 32118120 PMCID: PMC7014926 DOI: 10.12688/wellcomeopenres.15573.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 12/15/2022] Open
Abstract
Tuberculous meningitis (TBM) is the most severe and disabling form of tuberculosis (TB), accounting for around 1-5% of the global TB caseload, with mortality of approximately 20% in children and up to 60% in persons co-infected with human immunodeficiency virus even in those treated. Relatively few centres of excellence in TBM research exist and the field would therefore benefit from greater co-ordination, advocacy, collaboration and early data sharing. To this end, in 2009, 2015 and 2019 we convened the TBM International Research Consortium, bringing together approximately 50 researchers from five continents. The most recent meeting took place on 1 st and 2 nd March 2019 in Lucknow, India. During the meeting, researchers and clinicians presented updates in their areas of expertise, and additionally presented on the knowledge gaps and research priorities in that field. Discussion during the meeting was followed by the development, by a core writing group, of a synthesis of knowledge gaps and research priorities within seven domains, namely epidemiology, pathogenesis, diagnosis, antimicrobial therapy, host-directed therapy, critical care and implementation science. These were circulated to the whole consortium for written input and feedback. Further cycles of discussion between the writing group took place to arrive at a consensus series of priorities. This article summarises the consensus reached by the consortium concerning the unmet needs and priorities for future research for this neglected and often fatal disease.
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Affiliation(s)
- James A Seddon
- Infectious Diseases, Imperial College London, London, W2 1PG, UK
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, W2 1PG, UK
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, Western Cape, 8005, South Africa
| | - Robert Wilkinson
- Infectious Diseases, Imperial College London, London, W2 1PG, UK
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
- Francis Crick Institute, London, NW1 1AT, UK
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Anthony Figaji
- Neuroscience Institute, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Guy E Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
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14
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Imran D, Hill PC, McKnight J, van Crevel R. Establishing the cascade of care for patients with tuberculous meningitis. Wellcome Open Res 2019; 4:177. [PMID: 32118119 PMCID: PMC7008603 DOI: 10.12688/wellcomeopenres.15515.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 10/13/2023] Open
Abstract
Meningitis is a relatively rare form of tuberculosis, but it carries a high mortality rate, reaching 50% in some settings, with higher rates among patients with HIV co-infection and those with drug-resistant disease. Most studies of tuberculosis meningitis (TBM) tend to focus on better diagnosis, drug treatment and supportive care for patients in hospital. However, there is significant variability in mortality between settings, which may be due to specific variation in the availability and quality of health care services, both prior to, during, and after hospitalization. Such variations have not been studied thoroughly, and we therefore present a theoretical framework that may help to identify where efforts should be focused in providing optimal services for TBM patients. As a first step, we propose an adjusted cascade of care for TBM and patient pathway studies that might help identify factors that account for losses and delays across the cascade. Many of the possible gaps in the TBM cascade are related to health systems factors; we have selected nine domains and provide relevant examples of systems factors for TBM for each of these domains that could be the basis for a health needs assessment to address such gaps. Finally, we suggest some immediate action that could be taken to help make improvements in services. Our theoretical framework will hopefully lead to more health system research and improved care for patients suffering from this most dangerous form of tuberculosis.
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Affiliation(s)
- Darma Imran
- Department of Neurology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Philip C. Hill
- Center for International Health, University of Otago, Dunedin, New Zealand
| | - Jacob McKnight
- Oxford Health System Collaboration, Oxford University, Oxford, UK
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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15
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Imran D, Hill PC, McKnight J, van Crevel R. Establishing the cascade of care for patients with tuberculous meningitis. Wellcome Open Res 2019; 4:177. [PMID: 32118119 PMCID: PMC7008603 DOI: 10.12688/wellcomeopenres.15515.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/03/2022] Open
Abstract
Meningitis is a relatively rare form of tuberculosis, but it carries a high mortality rate, reaching 50% in some settings, with higher rates among patients with HIV co-infection and those with drug-resistant disease. Most studies of tuberculosis meningitis (TBM) tend to focus on better diagnosis, drug treatment and supportive care for patients in hospital. However, there is significant variability in mortality between settings, which may be due to specific variation in the availability and quality of health care services, both prior to, during, and after hospitalization. Such variations have not been studied thoroughly, and we therefore present a theoretical framework that may help to identify where efforts should be focused in providing optimal services for TBM patients. As a first step, we propose an adjusted cascade of care for TBM and patient pathway studies that might help identify factors that account for losses and delays across the cascade. Many of the possible gaps in the TBM cascade are related to health systems factors; we have selected nine domains and provide relevant examples of systems factors for TBM for each of these domains that could be the basis for a health needs assessment to address such gaps. Finally, we suggest some immediate action that could be taken to help make improvements in services. Our theoretical framework will hopefully lead to more health system research and improved care for patients suffering from this most dangerous form of tuberculosis.
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Affiliation(s)
- Darma Imran
- Department of Neurology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Philip C Hill
- Center for International Health, University of Otago, Dunedin, New Zealand
| | - Jacob McKnight
- Oxford Health System Collaboration, Oxford University, Oxford, UK
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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16
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Imran D, Satiti S, Sugianto P, Estiasari R, Maharani K, Pangeran D, Andini PW, Munir B, Mawuntu AHP, Susilawathi NM, Ritarwan K, Hartanto OS, Frida M, Ganiem AR, Gunawan D, Dian S, Sudewi AAR, van Crevel R. Barriers to diagnosis and management of CNS infections in Indonesia. Neurology 2019; 92:104-106. [PMID: 30617169 DOI: 10.1212/wnl.0000000000006732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Darma Imran
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK.
| | - Sekar Satiti
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Paulus Sugianto
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Riwanti Estiasari
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Kartika Maharani
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - David Pangeran
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Putri Widya Andini
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Badrul Munir
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Arthur H P Mawuntu
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Ni Made Susilawathi
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Kiking Ritarwan
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - O S Hartanto
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Meity Frida
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Ahmad Rizal Ganiem
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Dede Gunawan
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Sofiati Dian
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - A A R Sudewi
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Reinout van Crevel
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
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17
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Zawedde-Muyanja S, Nakanwagi A, Dongo JP, Sekadde MP, Nyinoburyo R, Ssentongo G, Detjen AK, Mugabe F, Nakawesi J, Karamagi Y, Amuge P, Kekitiinwa A, Graham SM. Decentralisation of child tuberculosis services increases case finding and uptake of preventive therapy in Uganda. Int J Tuberc Lung Dis 2019; 22:1314-1321. [PMID: 30355411 DOI: 10.5588/ijtld.18.0025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and limited contact screening and management contribute to low case finding in TB-endemic settings. OBJECTIVE To evaluate the implementation of a pilot project that strengthened diagnosis, treatment and prevention of child TB at peripheral health facilities in Uganda. METHODS In June 2015, health care workers at peripheral health facilities were trained to diagnose and treat child TB. Community health care workers were trained to screen household TB contacts. Before-and-after analysis as well as comparisons with non-intervention districts were used to evaluate impact on caseload and treatment outcomes. RESULTS By December 2016, the average number of children (age < 15 years) diagnosed with TB increased from 45 to 108 per quarter. The proportion of child TB among all TB cases increased from 8.8% to 15%, and the proportion completing treatment increased from 65% to 82%. Of 2270 child TB contacts screened, 55 (2.4%) were diagnosed with TB. Of 910 eligible child contacts, 670 (74%) started preventive therapy, 569 (85%) of whom completed therapy. CONCLUSION The strengthening of child TB services at peripheral health facilities in Uganda was associated with increased case finding, improved treatment outcomes and the successful implementation of contact screening and management.
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Affiliation(s)
- S Zawedde-Muyanja
- International Union Against Tuberculosis and Lung Disease, Paris, France;, The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala
| | - A Nakanwagi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J P Dongo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M P Sekadde
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Baylor College of Children's Medical Foundation, Kampala
| | | | - G Ssentongo
- Baylor College of Children's Medical Foundation, Kampala
| | - A K Detjen
- International Union Against Tuberculosis and Lung Disease, Paris, France;, United Nations Children's Fund, New York, USA
| | - F Mugabe
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala
| | | | | | - P Amuge
- Baylor College of Children's Medical Foundation, Kampala
| | - A Kekitiinwa
- Baylor College of Children's Medical Foundation, Kampala
| | - S M Graham
- International Union Against Tuberculosis and Lung Disease, Paris, France;, Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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18
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Rakhmawati W, Nilmanat K, Hatthakit U. Moving from fear to realization: Family engagement in tuberculosis prevention in children living in tuberculosis Sundanese households in Indonesia. Int J Nurs Sci 2019; 6:272-277. [PMID: 31508446 PMCID: PMC6722465 DOI: 10.1016/j.ijnss.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/24/2019] [Accepted: 06/05/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Children living in tuberculosis households need protection. However, families need to be engaged to prevent tuberculosis transmission to children. This study aimed to analyze the details of "moving from fear to realization," which is one category of a substantive theory of family engagement in tuberculosis prevention in children. METHODS Fourteen family caregivers participated as key informants after their families met the criteria. The participants were recruited at a lung clinic in West Java, Indonesia and followed up at their homes. The data were gathered using in-depth interviews and analyzed following the coding procedures of the Straussian grounded theory. FINDINGS "Moving from fear to realization" was the main category that emerged from the experiences of the Sundanese families to begin engaging in tuberculosis prevention in children living in tuberculosis households. It was composed of four sub-categories, namely, fear of tuberculosis, seeking information, following God's will, and awareness of tuberculosis transmission risks. CONCLUSIONS This study showed how a family moves from fear to the realization of tuberculosis transmission risks. Its findings are useful for nurses to provide optimum care in order to prevent tuberculosis transmission to children with household contact by providing both education and counseling for families.
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Affiliation(s)
- Windy Rakhmawati
- Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
- Department of Pediatric Nursing, Faculty of Nursing, University of Padjadjaran, Indonesia
| | - Kittikorn Nilmanat
- Department of Adult and Elderly Nursing, Prince of Songkla University, Songkhla, Thailand
| | - Urai Hatthakit
- Department of Nursing Administration, Prince of Songkla University, Songkhla, Thailand
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19
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Oxlade O, Trajman A, Benedetti A, Adjobimey M, Cook VJ, Fisher D, Fox GJ, Fregonese F, Hadisoemarto P, Hill PC, Johnston J, Long R, Obeng J, Ruslami R, Valiquette C, Menzies D. Enhancing the public health impact of latent tuberculosis infection diagnosis and treatment (ACT4): protocol for a cluster randomised trial. BMJ Open 2019; 9:e025831. [PMID: 30898826 PMCID: PMC6527985 DOI: 10.1136/bmjopen-2018-025831] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/17/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Treatment of latent tuberculosis (TB) infection (LTBI) is an important component of the End-TB strategy. However, the number of individuals who successfully complete LTBI treatment remains low as there are losses at all steps in the LTBI 'cascade-of-care'. The reasons for these losses are variable and highly dependent on the setting. We have planned a trial of a standardised public health approach to strengthen the management of household contacts (HHCs) of newly diagnosed patients with pulmonary TB. Assessing costs related to approach is a secondary objective of the study. METHODS AND ANALYSIS A cluster randomised trial will be conducted in 24 randomisation units (health facilities or groups of health facilities) in five countries. In Phase 1, at intervention sites, we will conduct a standardised assessment of the current LTBI programme, with a focus on cascade-of-care endpoints. Standardised open-ended questionnaires on practices, knowledge, attitudes and beliefs regarding TB prevention are then administered to key patient groups and healthcare workers. At each site, local stake-holders will review study findings and select solutions based on their acceptability, cost and effectiveness. In Phase 2, intervention clinics will implement the selected solutions, along with contact measurement registries and regular in-service LTBI management training. Control sites will continue their usual LTBI care with no explicit evaluation, strengthening or training activities. The primary study outcome is the number of HHC initiating LTBI treatment per newly diagnosed active TB patient, within 3 months of diagnosis of the index patient. An intention-to-treat analysis will be performed, using a Poisson regression approach. ETHICS AND DISSEMINATION Ethics approval from the MUHC ethical review board (ERB) was obtained in November 2015. During the study standardised tools will be developed and made publicly available. Key study findings and novel methodologic contributions will be detailed in publications and other dissemination activities. TRIAL REGISTRATION NUMBER NCT02810678; Pre-Results.
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Affiliation(s)
- Olivia Oxlade
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Anete Trajman
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Internal Medicine Graduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Benedetti
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Mênonli Adjobimey
- Centre National Hospitalier, Universitaire de Pneumo-Pthisiologie de Cotonou, Cotonou, Benin
| | - Victoria J Cook
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dina Fisher
- University of Calgary, Calgary, Alberta, Canada
| | - Gregory James Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Federica Fregonese
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Panji Hadisoemarto
- Department of Public Health, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Faculty of Medicine, Centre for International Health, University of Otago, Otago, New Zealand
| | - James Johnston
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Long
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rovina Ruslami
- Department of Biomedical Sciences, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - Chantal Valiquette
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Dick Menzies
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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20
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Lestari T, Graham S, van den Boogard C, Triasih R, Poespoprodjo JR, Ubra RR, Kenangalem E, Mahendradhata Y, Anstey NM, Bailie RS, Ralph AP. Bridging the knowledge-practice gap in tuberculosis contact management in a high-burden setting: a mixed-methods protocol for a multicenter health system strengthening study. Implement Sci 2019; 14:31. [PMID: 30890160 PMCID: PMC6425655 DOI: 10.1186/s13012-019-0870-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 01/12/2023] Open
Abstract
Background People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system—policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome. Methods This methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework. Discussion Use of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period. Study registration Australian New Zealand Clinical Trials Register 375803.
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Affiliation(s)
- Trisasi Lestari
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. .,Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Steve Graham
- Centre for International Child Health, Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Christel van den Boogard
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rina Triasih
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jeanne Rini Poespoprodjo
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Papuan Health and Community Development Foundation, Papua, Indonesia
| | | | - Enny Kenangalem
- Papuan Health and Community Development Foundation, Papua, Indonesia
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nicholas M Anstey
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ross S Bailie
- University Centre for Rural Health, School of Medicine, University of Sydney, Lismore, Australia
| | - Anna P Ralph
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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21
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Grace SG. Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review. J Paediatr Child Health 2019; 55:278-284. [PMID: 30604557 DOI: 10.1111/jpc.14359] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/15/2018] [Accepted: 12/04/2018] [Indexed: 11/28/2022]
Abstract
Isoniazid preventive therapy is one of the key interventions in reducing the risk of active disease among children exposed to tuberculosis. However, initiation and maintenance of this treatment is poor in many areas. This review summarises the existing literature on barriers to implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings. MEDLINE, EMBASE and CINAHL databases were used to search for primary research studies published between 1998 and 2018, specifically mentioning isoniazid preventive therapy, tuberculosis and children. Barriers identified in most study settings included absence of parental risk perception, health-care worker knowledge gaps and treatment access. Focusing on patient-centred care, enhancing community and health-care worker education and securing stable medication supply to effectively deliver this therapy is crucial in order to reduce childhood morbidity and mortality from tuberculosis.
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Affiliation(s)
- Samuel G Grace
- School of Clinical Medicine, University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
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22
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Ramos J, Wakoff-Pereira MF, Cordeiro-Santos M, Albuquerque MDFMD, Hill PC, Menzies D, Trajman A. Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis. ACTA ACUST UNITED AC 2019; 44:168-170. [PMID: 29791545 PMCID: PMC6044652 DOI: 10.1590/s1806-37562018000000019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jonas Ramos
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maria F Wakoff-Pereira
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Respiratory Epidemiology & Clinical Research Unit, McGill University, Montreal, Canada
| | - Anete Trajman
- Respiratory Epidemiology & Clinical Research Unit, McGill University, Montreal, Canada
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23
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Mwasubila YK, Sabi I, Kabyemera R, Ntinginya NE, Sauve R, Kidenya B. Tuberculosis Contact Screening and Isoniazid Preventive Therapy Among Children Under 5 in the Mbeya and Songwe Regions, Tanzania. East Afr Health Res J 2018; 2:29-32. [PMID: 34308172 PMCID: PMC8279253 DOI: 10.24248/eahrj-d-17-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/15/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction: The World Health Organization (WHO) recommends contact screening and initiation of isoniazid preventive therapy (IPT) for children under 5 years of age exposed to a sputum smear-positive (SS+) tuberculosis (TB) source case. We conducted this study in order to assess implementation of these recommendations in southwestern Tanzania. Methods: We conducted this cross-sectional study from June to August 2015 in 12 selected health facilities in the Mbeya and Songwe regions of Tanzania. Adult SS+ pulmonary TB patients living in the same household as children under 5 were enrolled. Structured questionnaires were used to obtain sociodemographic information and details about screening and intervention activity related to contact children under 5. Data were analysed using Stata version 11.0. Results: We enrolled 257 index cases, who collectively had 433 contact children under 5. The median age of the index cases was 34 years (interquartile range 28 to 41) and 52.9% were male. Out of 433 contacts, 31 (7.2%) were screened for TB, of whom 7 (22.6%) were treated for presumptive TB. Among those screened, 24 were not diagnosed with TB, of whom only 8 (33.3%) received IPT. Conclusion: Low uptake of TB contact screening and IPT administration among eligible children under 5 was observed in this study. Health-care workers should be sensitized to screening of household contacts of adults with SS+ TB and initiate IPT in those who are eligible.
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Affiliation(s)
- Yesaya K Mwasubila
- Department of Health, Songea District Council, Ruvuma, Tanzania.,School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Issa Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - Rogatus Kabyemera
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania.,Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Nyanda E Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - Reginald Sauve
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benson Kidenya
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Martinez L, Shen Y, Handel A, Chakraburty S, Stein CM, Malone LL, Boom WH, Quinn FD, Joloba ML, Whalen CC, Zalwango S. Effectiveness of WHO's pragmatic screening algorithm for child contacts of tuberculosis cases in resource-constrained settings: a prospective cohort study in Uganda. THE LANCET RESPIRATORY MEDICINE 2017; 6:276-286. [PMID: 29273539 DOI: 10.1016/s2213-2600(17)30497-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Tuberculosis is a leading cause of global childhood mortality; however, interventions to detect undiagnosed tuberculosis in children are underused. Child contact tracing has been widely recommended but poorly implemented in resource-constrained settings. WHO has proposed a pragmatic screening approach for managing child contacts. We assessed the effectiveness of this screening approach and alternative symptom-based algorithms in identifying secondary tuberculosis in a prospectively followed cohort of Ugandan child contacts. METHODS We identified index patients aged at least 18 years with microbiologically confirmed pulmonary tuberculosis at Old Mulago Hospital (Kampala, Uganda) between Oct 1, 1995, and Dec 31, 2008. Households of index patients were visited by fieldworkers within 2 weeks of diagnosis. Coprevalent and incident tuberculosis were assessed in household contacts through clinical, radiographical, and microbiological examinations for 2 years. Disease rates were compared among children younger than 16 years with and without symptoms included in the WHO pragmatic guideline (presence of haemoptysis, fever, chronic cough, weight loss, night sweats, and poor appetite). Symptoms could be of any duration, except cough (>21 days) and fever (>14 days). A modified WHO decision-tree designed to detect high-risk asymptomatic child contacts was also assessed, in which all asymptomatic contacts were classified as high risk (children younger than 3 years or immunocompromised [HIV-infected]) or low risk (aged 3 years or older and immunocompetent [HIV-negative]). We also assessed a more restrictive algorithm (ie, assessing only children with presence of chronic cough and one other tuberculosis-related symptom). FINDINGS Of 1718 household child contacts, 126 (7%) had coprevalent tuberculosis and 24 (1%) developed incident tuberculosis, diagnosed over the 2-year study period. Of these 150 cases of tuberculosis, 95 (63%) were microbiologically confirmed with a positive sputum culture. Using the WHO approach, 364 (21%) of 1718 child contacts had at least one tuberculosis-related symptom and 85 (23%) were identified as having coprevalent tuberculosis, 67% of all coprevalent cases detected (diagnostic odds ratio 9·8, 95% CI 6·8-14·5; p<0·0001). 1354 (79%) of 1718 child contacts had no symptoms, of whom 41 (3%) had coprevalent tuberculosis. The WHO approach was effective in contacts younger than 5 years: 70 (33%) of 211 symptomatic contacts had coprevalent disease compared with 23 (6%) of 367 asymptomatic contacts (p<0·0001). This approach was also effective in contacts aged 5 years and older: 15 (10%) of 153 symptomatic contacts had coprevalent disease compared with 18 (2%) of 987 asymptomatic contacts (p<0·0001). More coprevalent disease was detected in child contacts recommended for screening when the study population was restricted by HIV-serostatus (11 [48%] of 23 symptomatic HIV-seropositive child contacts vs two [7%] of 31 asymptomatic HIV-seropositive child contacts) or to only culture-confirmed cases (47 [13%] culture confirmed cases of 364 symptomatic child contacts vs 29 [2%] culture confirmed cases of 1354 asymptomatic child contacts). In the modified algorithm, high-risk asymptomatic child contacts were at increased risk for coprevalent disease versus low-risk asymptomatic contacts (14 [6%] of 224 vs 27 [2%] of 1130; p=0·0021). The presence of tuberculosis infection did not predict incident disease in either symptomatic or asymptomatic child contacts: in symptomatic contacts, eight (5%) of 169 infected contacts and six (5%) of 111 uninfected contacts developed incident tuberculosis (p=0·80). Among asymptomatic contacts, incident tuberculosis occurred in six (<1%) of 795 contacts infected at baseline versus four (<1%) of 518 contacts uninfected at baseline, respectively (p=1·00). INTERPRETATION WHO's pragmatic, symptom-based algorithm was an effective case-finding tool, especially in children younger than 5 years. A modified decision-tree identified 6% of asymptomatic child contacts at high risk for subclinical disease. Increasing the feasibility of child-contact tracing using these approaches should be encouraged to decrease tuberculosis-related paediatric mortality in high-burden settings, but this should be partnered with increasing access to microbiological point-of-care testing. FUNDING National Institutes of Health, Tuberculosis Research Unit, AIDS International Training and Research Program of the Fogarty International Center, and the Center for AIDS Research.
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Affiliation(s)
- Leonardo Martinez
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA; Institute of Global Health, University of Georgia, Athens, GA, USA; Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Andreas Handel
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Catherine M Stein
- Department of Population and Quantitative Health Sciences, Tuberculosis Research Unit & Department of Medicine, Case Western Reserve University, Cleveland, OH, USA; Uganda-CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda
| | - LaShaunda L Malone
- Division of Infectious Disease, Department of Medicine and Tuberculosis Research Unit, Case Western Reserve University, Cleveland, OH, USA; Uganda-CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda
| | - W Henry Boom
- Division of Infectious Disease, Department of Medicine and Tuberculosis Research Unit, Case Western Reserve University, Cleveland, OH, USA; Uganda-CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda
| | - Frederick D Quinn
- University of Georgia, Department of Veterinary Medicine, Athens, GA, USA
| | - Moses L Joloba
- Department of Immunology/Molecular Biology and Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA; Institute of Global Health, University of Georgia, Athens, GA, USA
| | - Sarah Zalwango
- Uganda-CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda
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Salame FM, Ferreira MD, Belo MT, Teixeira EG, Cordeiro-Santos M, Ximenes RA, de Albuquerque MDFM, Hill PC, Menzies D, Trajman A. Knowledge about tuberculosis transmission and prevention and perceptions of health service utilization among index cases and contacts in Brazil: Understanding losses in the latent tuberculosis cascade of care. PLoS One 2017; 12:e0184061. [PMID: 28934228 PMCID: PMC5608201 DOI: 10.1371/journal.pone.0184061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/17/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Tuberculosis contacts are candidates for active and latent tuberculosis infection screening and eventual treatment. However, many losses occur in the different steps of the contacts’ cascade of care. Reasons for this are poorly understood. Objective To describe the different steps where losses in the contact cascade occur and to explore knowledge and attitudes regarding tuberculosis transmission/prevention and perceptions about tuberculosis services in order to understand the reasons for losses from the tuberculosis service users’ perspective. Design We collected routine data from the index case and contact registry books and from patients’ records to build the cascade of care of contacts in 12 health facilities in three Brazilian cities with high tuberculosis incidence rates. During a knowledge, attitudes and practices (KAP) survey, trained interviewers administered a semi-structured questionnaire to 138 index cases and 98 contacts. Results Most of the losses in the cascade occurred in the first two steps (contact identification, 43% and tuberculin skin testing placement, 91% of the identified contacts). Among KAP-interviewed contacts, 67% knew how tuberculosis is transmitted, 87% knew its key symptoms and 81% declared they would take preventive therapy if prescribed. Among KAP-interviewed index cases, 67% knew they could spread tuberculosis, 70% feared for the health of their families and 88% would like their family to be evaluated in the same services. Conclusion Only a small proportion of contacts are evaluated for active and latent tuberculosis, despite their—and their index cases’—reasonable knowledge, positive attitudes towards prevention and satisfaction with tuberculosis services. In these services, education of service users would not be a sufficient solution. Healthcare workers’ and managers’ perspective, not explored in this study, may bring more light to this subject.
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Affiliation(s)
- Flavia Matos Salame
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | | | | | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Ricardo Arraes Ximenes
- Universidade Federal de Pernambuco, Recife, PE, Brazil
- Instituto de Pesquisa Aggeu Magalhães, Fiocruz, Recife, PE, Brazil
| | | | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Global Health Program, McGill University, Montreal, Canada
| | - Anete Trajman
- Global Health Program, McGill University, Montreal, Canada
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, RJ, Brazil
- * E-mail:
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Szkwarko D, Hirsch-Moverman Y, Du Plessis L, Du Preez K, Carr C, Mandalakas AM. Child contact management in high tuberculosis burden countries: A mixed-methods systematic review. PLoS One 2017; 12:e0182185. [PMID: 28763500 PMCID: PMC5538653 DOI: 10.1371/journal.pone.0182185] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/13/2017] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children.
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Affiliation(s)
- Daria Szkwarko
- Department of Family Medicine and Community Health, The University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Yael Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America
- Department of Epidemiology, Columbia University, New York, New York, United States of America
| | - Lienki Du Plessis
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Karen Du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Catherine Carr
- Lamar Soutter Library, The University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Anna M. Mandalakas
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
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Egere U, Sillah A, Togun T, Kandeh S, Cole F, Jallow A, Able-Thomas A, Hoelscher M, Heinrich N, Hill PC, Kampmann B. Isoniazid preventive treatment among child contacts of adults with smear-positive tuberculosis in The Gambia. Public Health Action 2016; 6:226-231. [PMID: 28123958 DOI: 10.5588/pha.16.0073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: Greater Banjul area of The Gambia. Objectives: To evaluate uptake, adherence and completion of treatment among tuberculosis (TB) exposed children in The Gambia when isoniazid preventive treatment (IPT) is delivered at home Design: Child (age <5 years) contacts of adults with smear-positive TB were prospectively enrolled. Following symptom screening, tuberculin skin testing and clinical evaluation where indicated, those without disease were placed on daily isoniazid, provided monthly at home. Adherence was assessed by pill counts and IsoScreen™ urine test. Results: Of 404 contacts aged <5 years, 368 (91.1%) were offered IPT. Of the 328 (89.4%) for whom consent was received and who commenced IPT, 18 (5.5%) dropped out and 310 (94.5%) remained on IPT to the end of the 6-month regimen. Altogether, 255/328 children (77.7%, 95%CI 73.2-82.2) completed all 6 months, with good adherence. The IsoScreen test was positive in 85.3% (435/510) of all tests among those defined as having good adherence by pill count and in 16% (8/50) of those defined as having poor adherence (P < 0.001). A cascade of care analysis showed an overall completion rate with good adherence of 61% for all child contacts. Conclusion: Home-delivered IPT among child contacts of adults with smear-positive TB in The Gambia achieved verifiable high uptake and adherence rates. System rather than patient factors are likely to determine the success of IPT at national level.
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Affiliation(s)
- U Egere
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - A Sillah
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - T Togun
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia ; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - S Kandeh
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - F Cole
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - A Jallow
- National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia
| | - A Able-Thomas
- National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia
| | - M Hoelscher
- Centre for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - N Heinrich
- Centre for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia ; Centre for International Child Health, Academic Department of Paediatrics, Imperial College London, London, UK
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Graham SM. The management of infection with Mycobacterium tuberculosis in young children post-2015: an opportunity to close the policy-practice gap. Expert Rev Respir Med 2016; 11:41-49. [DOI: 10.1080/17476348.2016.1267572] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
- Department of Tuberculosis and HIV, International Union Against Tuberculosis and Lung Disease, Paris, France
- Centre for International Health, The Burnet Institute, Melbourne, Australia
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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: 304] [Impact Index Per Article: 38.0] [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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Wysocki AD, Villa TCS, Arakawa T, Brunello MEF, Vendramini SHF, Monroe AA, Kritski AL. Latent Tuberculosis Infection Diagnostic and Treatment Cascade among Contacts in Primary Health Care in a City of Sao Paulo State, Brazil: Cross-Sectional Study. PLoS One 2016; 11:e0155348. [PMID: 27285720 PMCID: PMC4902216 DOI: 10.1371/journal.pone.0155348] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/27/2016] [Indexed: 11/18/2022] Open
Abstract
Background Diagnosis and treatment of latent tuberculosis infection (LTBI) is a tool for global TB control, especially in close contacts. But data is scarce in high burden countries, under field conditions, including data on the benefits of LTBI management. Objective To analyze the LTBI diagnosis and treatment cascade among contacts in primary health care (PHC) services in São José do Rio Preto—SP, Brazil. Methods Cross-sectional design, conducted with contacts of pulmonary TB patients followed in all PHC services. Data was collected from May to September 2014 in the Reporting System for TB cases (TBWEB) and Reporting System for Chemoprophylaxis. Medical records and treatment follow-up forms were reviewed and all the nurses responsible for TB in PHC services were interviewed. Results Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Overall, among 267 screened, only 64 (24%) started LTBI treatment. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified. Conclusions There is a need for better organization of the surveillance and investigation routine for contacts in PHC, considering the reorganization of the work process and the features of the local health system.
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Affiliation(s)
- Anneliese Domingues Wysocki
- College of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Mato Grosso do Sul, Brazil
- Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil
- * E-mail:
| | - Tereza Cristina Scatena Villa
- Department of Public Health, School of Nursing of Ribeirao Preto–University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil
| | - Tiemi Arakawa
- Department of Public Health, School of Nursing of Ribeirao Preto–University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil
| | - Maria Eugênia Firmino Brunello
- Department of Public Health, School of Nursing of Ribeirao Preto–University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil
| | - Silvia Helena Figueiredo Vendramini
- Department of Public Health Nursing and Professional Orientation, School of Medicine of Sao Jose do Rio Preto, Sao Jose do Rio Preto, Sao Paulo, Brazil
- Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil
| | - Aline Aparecida Monroe
- Department of Public Health, School of Nursing of Ribeirao Preto–University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil
| | - Afranio Lineu Kritski
- Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil
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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: 56] [Impact Index Per Article: 7.0] [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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Mendonça AMC, Kritski AL, Land MGP, Sant’Anna CC. Abandonment of Treatment for Latent Tuberculosis Infection and Socioeconomic Factors in Children and Adolescents: Rio De Janeiro, Brazil. PLoS One 2016; 11:e0154843. [PMID: 27149514 PMCID: PMC4858286 DOI: 10.1371/journal.pone.0154843] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/20/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Routine data on the use of isoniazid preventive therapy (IPT) in children and adolescents are scarce in high tuberculosis (TB) burden countries. OBJECTIVE To describe the factors related to abandonment of IPT in children and adolescents with latent tuberculosis infection (LTBI) receiving routine care. METHODS Retrospective (2005-2009) descriptive study of 286 LTBI cases with indication of IPT and serviced at a pediatric hospital in the State of Rio de Janeiro, Brazil. Survival analysis of the risk of abandonment of IPT over six months was performed, including multivariate analysis using the Cox proportional hazards model. RESULTS Out of the 245 cases of LTBI included, 62 abandoned IPT (25.3%; 95% CI: 20%-31%). On multivariate analysis, the variables related to the IPT abandonment hazard ratio were the Human Development Index (HDI) (hazard ratio-HR: 0.004; 0.000-0.569) of the place of residence and the contact with adults that were not undergoing anti-TB treatment (HR: 7.30; 1.00-53.3). CONCLUSION This study reveals the relevance of the relation of abandonment of IPT to the socioeconomic conditions at the place of residence and poor adherence to the active TB treatment. Educational measures to stimulate preventive treatment of child contacts and curative treatment of index cases should target the full familial setting.
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Affiliation(s)
| | - Afrânio Lineu Kritski
- Academic Tuberculosis Programme, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Graham SM, Grzemska M, Brands A, Nguyen H, Amini J, Triasih R, Talukder K, Ahmed S, Amanullah F, Kumar B, Tufail P, Detjen A, Marais B, Hennig C, Islam T. Regional initiatives to address the challenges of tuberculosis in children: perspectives from the Asia-Pacific region. Int J Infect Dis 2016; 32:166-9. [PMID: 25809775 DOI: 10.1016/j.ijid.2014.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/06/2014] [Indexed: 11/28/2022] Open
Abstract
Increasing attention is being given to the challenges of management and prevention of tuberculosis in children and adolescents. There have been a number of recent important milestones achieved at the global level to address this previously neglected disease. There is now a need to increase activities and build partnerships at the regional and national levels in order to address the wide policy-practice gaps for implementation, and to take the key steps outlined in the Roadmap for Child Tuberculosis published in 2013. In this article, we provide the rationale and suggest strategies illustrated with examples to improve diagnosis, management, outcomes and prevention for children with tuberculosis in the Asia-Pacific region, with an emphasis on the need for greatly improved recording and reporting. Effective collaboration with community engagement between the child health sector, the National Tuberculosis control Programmes, community-based services and the communities themselves are essential.
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Affiliation(s)
- Stephen M Graham
- International Union Against Tuberculosis and Lung Disease, Paris, France; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for International Health, Burnet Institute, Melbourne, Australia.
| | - Malgorzata Grzemska
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Annemieke Brands
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Huong Nguyen
- KNCV Tuberculosis Foundation Country Office, Ha Noi, Viet Nam
| | - James Amini
- National Department for Health, Port Moresby, Papua New Guinea
| | - Rina Triasih
- Department of Pediatrics, Dr. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Shakil Ahmed
- Bangladesh Paediatric Association TB CARE II Porject, Dhaka, Bangladesh
| | | | | | | | - Anne Detjen
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Cornelia Hennig
- Stop TB and Leprosy Unit, Division of communicable Diseases, World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | - Tauhid Islam
- Stop TB and Leprosy Unit, Division of communicable Diseases, World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
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Mendonça AMC, Kritski AL, Sant'Anna CC. Tuberculosis contact tracing among children and adolescent referred to children's hospital in Rio de Janeiro, Brazil. Braz J Infect Dis 2015; 19:296-301. [PMID: 25636186 PMCID: PMC9425340 DOI: 10.1016/j.bjid.2014.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To describe the investigation of latent tuberculosis infection and indication for isoniazid preventive therapy in children and adolescents evaluated at the children's hospital. Methods This retrospective study examines all latent tuberculosis infection subjects with indication for isoniazid preventive therapy attended during 2002–2009 at the pulmonology outpatient clinic from children's hospital in Rio de Janeiro, Brazil. The subjects were classified into three groups by origin: (G1) primary and secondary health units; (G2) children's hospital-pulmonology outpatient clinic; and (G3) children's hospital-specialty outpatient clinics. The association between the variables examined and G1 was analyzed using univariate analysis. Results Of the 286 latent tuberculosis infection cases included 169 (59.1%) were from G1, 56 (19.6%) from G2, and 61 (21.3%) from G3. Latent tuberculosis infection diagnosis without isoniazid preventive therapy prescription was present in 142 (49.6%) cases before arrival at the pulmonology outpatient clinic: 135 (95.1%) from G1, three (2.1%) from G2, and four (2.8%) from G3. Variables associated with G1 were presence of isoniazid preventive therapy criteria before attending the pulmonology outpatient clinic (OR: 62.3; 26.6–146.2), negative HIV infection status (OR: 9.44; 1.16–76.3); contact with pulmonary tuberculosis (OR: 5.57; 1.99–15.5), and residing in Rio de Janeiro city (OR: 1.89; 1.04–3.44). Conclusion Strategies that increase latent tuberculosis infection identification and isoniazid preventive therapy prescription in primary and secondary health units are urgently needed.
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Affiliation(s)
| | - Afrânio Lineu Kritski
- School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Clemax Couto Sant'Anna
- School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Hall C, Sukijthamapan P, dos Santos R, Nourse C, Murphy D, Gibbons M, Francis JR. Challenges to delivery of isoniazid preventive therapy in a cohort of children exposed to tuberculosis in Timor-Leste. Trop Med Int Health 2015; 20:730-6. [PMID: 25682846 DOI: 10.1111/tmi.12479] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the number and geographic location of children aged <5 years exposed to sputum smear-positive tuberculosis (TB) in Timor-Leste, to determine the proportion evaluated for isoniazid preventive therapy (IPT) and to review the programmatic challenges present in delivering IPT to this cohort. METHODS A total of 256 consecutive sputum smear-positive TB index cases diagnosed at Bairo Pite Clinic between August 2013 and July 2014 were interviewed about places of residence and household contacts <5 years of age in the 3 months preceding diagnosis. Attendance of these contacts for screening and the outcome of screening were recorded prospectively. RESULTS The majority (225 of 256, 88%) of index cases resided in Dili, but 73 of 225 (32%) of these also had a second address outside the capital. A total of 255 contacts were identified; 172 of 255 (67%) of whom lived in Dili district and 83 of 255 (33%) of whom resided in remote districts. Only 66 of 255 (26%) contacts attended for evaluation for IPT, of whom 46 of 255 (18%) started IPT and nine of 255 (3.5%) were diagnosed with TB. Attendance was significantly less likely when the index case was not the parent of the child contact. CONCLUSIONS Sputum smear-positive pulmonary TB cases frequently result in household exposure of children <5 years in Timor-Leste, and provision of IPT is suboptimal. Contacts are located in diverse and distant locations. Further studies to delineate access barriers to IPT and review programmatic models that will facilitate IPT scale up in Timor-Leste are needed.
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Affiliation(s)
- Charlotte Hall
- Bairo Pite Clinic, Dili, Timor-Leste; Hull and East Yorkshire NHS Trust, Hull, East Yorkshire, UK
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Fox GJ, Loan LP, Nhung NV, Loi NT, Sy DN, Britton WJ, Marks GB. Barriers to adherence with tuberculosis contact investigation in six provinces of Vietnam: a nested case-control study. BMC Infect Dis 2015; 15:103. [PMID: 25886411 PMCID: PMC4377211 DOI: 10.1186/s12879-015-0816-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/10/2015] [Indexed: 12/03/2022] Open
Abstract
Background Close contacts of patients with tuberculosis (TB) have a substantial risk of developing the disease, particularly during the first year after exposure. Household contact investigation has recently been recommended as a strategy to enhance case detection in high-burden countries. However the barriers to its implementation in these settings remain poorly understood. Methods A nested case–control study was conducted in Vietnam within the context of a large cluster randomised controlled trial of active screening for TB in household contacts of patients with pulmonary TB. The study population comprised contacts (and their index patients) from 12 Districts in six provinces throughout the country. Cases were contacts (and their index patients) that did not attend the scheduled screening appointment. Controls were those who did attend. We assessed relevant knowledge, attitudes and practices in cases and controls. Results The acceptability of contact investigation was high among both cases (n = 109) and controls (n = 194). Both cases (47%) and controls (36%) commonly reported discrimination against people with TB. Cases were less likely than controls to understand that sharing sleeping quarters with a TB patient increased their risk of disease (OR 0.46, 0.27 – 0.78) or recognise TB as an infectious disease (OR 0.65, 0.39 – 1.08). A higher proportion of cases than controls held the mistaken traditional belief that a non-infectious form of TB caused the disease (OR 1.69, 1.02 – 2.78). Conclusions The knowledge, attitudes and practices of contacts and TB patients influence their ongoing participation in contact investigation. TB case detection policies in high-prevalence settings can be strengthened by systematically evaluating and addressing locally important barriers to attendance. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12610000600044. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0816-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gregory James Fox
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia. .,Sydney Medical School, University of Sydney, Sydney, 2006, Australia.
| | - Le Phuong Loan
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia.
| | - Nguyen Viet Nhung
- National Lung Hospital, 463 Hoang Hoa Tham Street, Ba Dinh, Hanoi, Vietnam.
| | - Nguyen Thi Loi
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia.
| | - Dinh Ngoc Sy
- National Lung Hospital, 463 Hoang Hoa Tham Street, Ba Dinh, Hanoi, Vietnam.
| | - Warwick John Britton
- Sydney Medical School, University of Sydney, Sydney, 2006, Australia. .,Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Missenden Road Camperdown, Sydney, 2050, Australia.
| | - Guy Barrington Marks
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, Sydney, 2037, Australia. .,South Western Sydney Clinical School, University of New South Wales, Sydney, 2052, Australia.
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Berg MR. Mangelfull oppfølging av barn utsatt for tuberkulosesmitte. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014. [DOI: 10.4045/tidsskr.14.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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