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Nair D, Thekkur P, Mbithi I, Khogali M, Zachariah R, Dar Berger S, Satyanarayana S, Kumar AMV, Kathure I, Mwangi J, Bochner AF, McClelland A, Chakaya JM, Harries AD. Timeliness metrics for screening and preventing TB in household contacts of pulmonary TB patients in Kenya. IJTLD OPEN 2024; 1:41-49. [PMID: 38919414 PMCID: PMC11189597 DOI: 10.5588/ijtldopen.23.0545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 06/27/2024]
Abstract
BACKGROUND The study assessed whether a "7-1-7" timeliness metric for screening and TB preventive therapy (TPT) could be implemented for household contacts (HHCs) of index patients with bacteriologically confirmed pulmonary TB under routine programmatic settings in Kenya. METHODS A longitudinal cohort study conducted among index patients and their HHCs in 12 health facilities, Kiambu County, Kenya. RESULTS Between January and June 2023, 95% of 508 index patients had their HHCs line-listed within 7 days of initiating anti-TB treatment ("First 7"). In 68% of 1,115 HHCs, screening outcomes were ascertained within 1 day of line-listing ("Next 1"). In 65% of 1,105 HHCs eligible for further evaluation, anti-TB treatment, TPT or a decision for no drugs was made within 7 days of screening ("Second 7"). Altogether, 62% of screened HHCs started TPT during the "7-1-7" period compared with 58% in a historical cohort. Main barriers to TPT uptake were HHCs not consulting clinicians, HHCs being unwilling to initiate TPT and drug shortages. Healthcare workers felt that a timeliness metric was valuable for streamlining HHC management and proposed "3-5-7" as a workable alternative. CONCLUSIONS The national TB programme must generate awareness about TPT, ensure uninterrupted drug supplies and assess whether the "3-5-7" metric can be operationalised.
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Affiliation(s)
- D Nair
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - I Mbithi
- Respiratory Society of Kenya, Nairobi, Kenya
| | - M Khogali
- Institute of Public Health, College of Medicine and Health Sciences, University of the United Arab Emirates, Al Ain, United Arab Emirates
| | - R Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - S Dar Berger
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
- Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore, India
| | - I Kathure
- Division of National TB, Leprosy and Lung Disease Programme, Ministry of Health, Nairobi
| | - J Mwangi
- Department of Health, Kiambu County Government, Kiambu, Kenya
| | - A F Bochner
- Resolve to Save Lives, New York City, NY, USA
| | | | - J M Chakaya
- Respiratory Society of Kenya, Nairobi, Kenya
- Department of Medicine, Dermatology and Therapeutics, Kenyatta University School of Medicine, Nairobi, Kenya
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Felisia F, Triasih R, Nababan BWY, Sanjaya GY, Dewi SC, Rahayu ES, Unwanah L, du Cros P, Chan G. High Tuberculosis Preventive Treatment Uptake and Completion Rates Using a Person-Centered Approach among Tuberculosis Household Contact in Yogyakarta. Trop Med Infect Dis 2023; 8:520. [PMID: 38133452 PMCID: PMC10747839 DOI: 10.3390/tropicalmed8120520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Coverage of tuberculosis preventive treatment (TPT) in Indonesia is inadequate, and persons who start TPT often do not complete treatment. In 2020, Zero TB Yogyakarta implemented person-centered contact investigation and shorter TPT regimen provision in collaboration with primary health care centers. Between 1 January 2020 and 31 August 2022, we assessed eligibility for TPT among household contacts of persons with bacteriologically confirmed TB (index cases) and offered them a 3-month TPT regimen (3RH or 3HP). A dedicated nurse monitored contacts on TPT for treatment adherence and side effects every week in the first month and every two weeks in the next months. Contacts were also able to contact a nurse by phone or ask for home visits at any point if they had any concerns. A total of 1016 contacts were eligible for TPT: 772 (78.8%) started short regimen TPT with 706 (91.5%) completing their TPT. Side effects were reported in 26 (39%) of the non-completion group. We conclude that high rates of TPT uptake and completion among contacts assessed as eligible for TPT can be achieved through person-centered care and the use of shorter regimens. Side-effect monitoring and management while on TPT is vital for improving TPT completion.
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Affiliation(s)
- Felisia Felisia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
| | - Rina Triasih
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
- Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia
| | - Betty Weri Yolanda Nababan
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
| | - Guardian Yoki Sanjaya
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman 55281, Yogyakarta, Indonesia;
| | - Setyogati Candra Dewi
- Yogyakarta City Health Office, Yogyakarta 55165, Yogyakarta, Indonesia; (S.C.D.); (E.S.R.); (L.U.)
| | - Endang Sri Rahayu
- Yogyakarta City Health Office, Yogyakarta 55165, Yogyakarta, Indonesia; (S.C.D.); (E.S.R.); (L.U.)
| | - Lana Unwanah
- Yogyakarta City Health Office, Yogyakarta 55165, Yogyakarta, Indonesia; (S.C.D.); (E.S.R.); (L.U.)
| | - Philipp du Cros
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia (G.C.)
| | - Geoffrey Chan
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia (G.C.)
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Vo LNQ, Nguyen VN, Nguyen NTT, Dong TTT, Codlin A, Forse R, Truong HT, Nguyen HB, Dang HTM, Truong VV, Nguyen LH, Mac TH, Le PT, Tran KT, Ndunda N, Caws M, Creswell J. Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study. BMJ Open 2023; 13:e071537. [PMID: 36759036 PMCID: PMC9923314 DOI: 10.1136/bmjopen-2022-071537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES To end tuberculosis (TB), the vast reservoir of 1.7-2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems unlikely. This study assessed the feasibility of using interferon-γ release assays (IGRAs) at lower healthcare levels and the comparative performance of 3-month and 9-month daily TPT regimens (3HR/9H). DESIGN, SETTING, PARTICIPANTS AND INTERVENTION This cohort study was implemented in two provinces of Viet Nam from May 2019 to September 2020. Participants included household contacts (HHCs), vulnerable community members and healthcare workers (HCWs) recruited at community-based TB screening events or HHC investigations at primary care centres, who were followed up throughout TPT. PRIMARY AND SECONDARY OUTCOMES We constructed TBI care cascades describing indeterminate and positivity rates to assess feasibility, and initiation and completion rates to assess performance. We fitted mixed-effects logistic and stratified Cox models to identify factors associated with IGRA positivity and loss to follow-up (LTFU). RESULTS Among 5837 participants, the indeterminate rate was 0.8%, and 30.7% were IGRA positive. TPT initiation and completion rates were 63.3% (3HR=61.2% vs 9H=63.6%; p=0.147) and 80.6% (3HR=85.7% vs 9H=80.0%; p=0.522), respectively. Being male (adjusted OR=1.51; 95% CI: 1.28 to 1.78; p<0.001), aged 45-59 years (1.30; 1.05 to 1.60; p=0.018) and exhibiting TB-related abnormalities on X-ray (2.23; 1.38 to 3.61; p=0.001) were associated with positive IGRA results. Risk of IGRA positivity was lower in periurban districts (0.55; 0.36 to 0.85; p=0.007), aged <15 years (0.18; 0.13 to 0.26; p<0.001), aged 15-29 years (0.56; 0.42 to 0.75; p<0.001) and HCWs (0.34; 0.24 to 0.48; p<0.001). The 3HR regimen (adjusted HR=3.83; 1.49 to 9.84; p=0.005) and HCWs (1.38; 1.25 to 1.53; p<0.001) showed higher hazards of LTFU. CONCLUSION Providing IGRAs at lower healthcare levels is feasible and along with shorter regimens may expand access and uptake towards meeting TPT targets, but scale-up may require complementary advocacy and education for beneficiaries and providers.
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Affiliation(s)
| | | | | | | | - Andrew Codlin
- Friends for International TB Relief, Ha Noi, Viet Nam
| | - Rachel Forse
- TB Programs, Friends for International TB Relief, Ho Chi Minh City, Viet Nam
- Department of Global Public Health, The Health and Social Protection Action Research & Knowledge Sharing network (SPARKS), Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | - Khoa Tu Tran
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | - Maxine Caws
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Birat Nepal Medical Trust, Kathmandu, Nepal
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Preventive Treatment for Household Contacts of Drug-Susceptible Tuberculosis Patients. Pathogens 2022; 11:pathogens11111258. [DOI: 10.3390/pathogens11111258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
People who live in the household of someone with infectious pulmonary tuberculosis are at a high risk of tuberculosis infection and subsequent progression to tuberculosis disease. These individuals are prioritized for contact investigation and tuberculosis preventive treatment (TPT). The treatment of TB infection is critical to prevent the progression of infection to disease and is prioritized in household contacts. Despite the availability of TPT, uptake in household contacts is poor. Multiple barriers prevent the optimal implementation of these policies. This manuscript lays out potential next steps for closing the policy-to-implementation gap in household contacts of all ages.
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Matteelli A, Alffenaar JWC. Diagnosis and treatment of tuberculosis infection: can it contribute to achieving tuberculosis elimination? Eur Respir J 2022; 60:60/1/2200540. [PMID: 35798372 DOI: 10.1183/13993003.00540-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/05/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Alberto Matteelli
- Institute of Infectious and Tropical diseases, WHO Collaborating Centre for Tuberculosis/HIV coinfection and for the Tuberculosis Elimination Strategy, University of Brescia, Brescia, Italy
| | - Jan-Willem C Alffenaar
- Sydney Institute for Infectious Diseases, The University of Sydney School of Pharmacy Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Westmead Hospital, Sydney, Australia
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Fa L, Xu C, Cheng J, Zhang H. Acceptability of Tuberculosis Preventive Treatment Strategies Among Healthcare Workers Using an Online Survey - China, 2021. China CDC Wkly 2022; 4:211-215. [PMID: 35433078 PMCID: PMC9005477 DOI: 10.46234/ccdcw2022.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
What is already known about this topic? In the absence of effective vaccines, tuberculosis preventive treatment (TPT) is essential for the rapid decrease in incidences of tuberculosis (TB), and healthcare workers’ acceptability is vital to implementing TPT. What is added by this report? Overall, 86.5% of healthcare workers knew what TPT was. Most (56.3%) healthcare workers agreed to implement TPT among high-risk groups with latent tuberculosis infection. Drug resistance, adverse events, and unguaranteed efficacy were three main barriers for healthcare workers in accepting TPT. What are the implications for public health practice? To further promote and implement TPT in China, practical measures included policy support, high-quality training for healthcare workers, and enhanced public awareness of TB prevention and control.
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Affiliation(s)
- Lifeng Fa
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Caihong Xu
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Cheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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