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Seid G, Alemu A, Diriba G, Zerihun B, Abebaw Y, Moga S, Abdela S, Habtemariam S, Gumi B. Routine tuberculosis contact investigation yield and preventive treatment cascade in central Ethiopia. Heliyon 2024; 10:e30942. [PMID: 38770348 PMCID: PMC11103515 DOI: 10.1016/j.heliyon.2024.e30942] [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: 01/05/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction There is a global gap between tuberculosis incident cases and the notified cases. Active household contact investigation is one of the strategies to narrow this gap. It has the advantage of giving early diagnosis and preventive treatment to vulnerable and eligible groups. This study assessed the practice of contact investigation and tuberculosis preventive treatment adherence in central Ethiopia. Method A cross-sectional study covering all registered bacteriologically confirmed pulmonary tuberculosis patients and their close contacts was conducted in central Ethiopia from January 1, 2022, to December 30, 2022. Result A total of 1372 household contacts were declared by the index cases. From these 79.44 % (1090) contacts received a one-time tuberculosis screening giving a total of four (0.36 %) active TB cases. Among 484 household contacts of drug-resistant tuberculosis index cases, 5.53 % (14) had presumptive tuberculosis and 0.79 % (2) had active tuberculosis. While among 837 household contacts of drug-susceptible tuberculosis index cases presumptive TB cases were 1.91 % (16) and active TB cases were 0.23 % (2). Of the 142 eligible under 15 children 81.69 % (116) had started tuberculosis preventive treatment and 84.48 % (98) completed the treatment. On multivariable logistic regression, the associated factor for tuberculosis preventive treatment non-adherence was age 2-5 years (aOR, 0.02, 95 % CI (0.002-0.20) and age 5-15 years (aOR, 0.04,95 % CI (0.002-0 0.95)) P=<0.05). Conclusion There was low contact screening practice in the DR-TB index cases as compared to national and global targets. The yield of routine contact investigation was low and it indicates the quality of screening. Tuberculosis preventive treatment initiation and completion rates were also low as compared to those of many other countries and global achievements which need further improvement, especially for completion. Alternative mechanisms should be planned to increase the yield of tuberculosis screening and tuberculosis preventive treatment adherence.
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Affiliation(s)
- Getachew Seid
- Ethiopian Public Health Institute, P.o.box 1242, Addis Ababa Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Po. Box 1176, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopian Public Health Institute, P.o.box 1242, Addis Ababa Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Po. Box 1176, Addis Ababa, Ethiopia
| | - Getu Diriba
- Ethiopian Public Health Institute, P.o.box 1242, Addis Ababa Ethiopia
| | - Betselot Zerihun
- Ethiopian Public Health Institute, P.o.box 1242, Addis Ababa Ethiopia
| | - Yeshiwork Abebaw
- Ethiopian Public Health Institute, P.o.box 1242, Addis Ababa Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Po. Box 1176, Addis Ababa, Ethiopia
| | - Shewki Moga
- Ethiopian Public Health Institute, P.o.box 1242, Addis Ababa Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Po. Box 1176, Addis Ababa, Ethiopia
| | - Saro Abdela
- Ethiopian Public Health Institute, P.o.box 1242, Addis Ababa Ethiopia
| | - Solomon Habtemariam
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Po. Box 1176, Addis Ababa, Ethiopia
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Po. Box 1176, Addis Ababa, Ethiopia
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Alvi Y, Philip S, Anand T, Chinnakali P, Islam F, Singla N, Thekkur P, Khanna A, Vashishat BK. Situation Analysis of Early Implementation of Programmatic Management of Tuberculosis Preventive Treatment among Household Contacts of Pulmonary TB Patients in Delhi, India. Trop Med Infect Dis 2024; 9:24. [PMID: 38251221 PMCID: PMC10818279 DOI: 10.3390/tropicalmed9010024] [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: 10/25/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Tuberculosis Preventive Treatment (TPT) is a powerful tool for preventing the TB infection from developing into active TB disease, and has recently been expanded to all household contacts of TB cases in India. This study employs a mixed-methods approach to conduct a situational analysis of the initial phase of TPT implementation among household contacts of pulmonary TB patients in three districts of Delhi, India. It was completed using a checklist based assessments, care cascade data, and qualitative analysis. Our observations indicated that organizational structure and planning were established, but implementation of TPT was suboptimal with issues in drug availability and procurement, budget, human resources, and training. Awareness and motivation, and shorter regimen, telephonic assessment, and collaboration with NGOs emerged as enablers. Apprehension about taking TPT, erratic drug supply, long duration of treatment, side effects, overburden, large population, INH resistance, data entry issues, and private provider reluctance emerged as barriers. The study revealed potential solutions for optimizing TPT implementation. It is evident that, while progress has been made in TPT implementation, there is room for improvement and refinement across various domains.
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Affiliation(s)
- Yasir Alvi
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi 110062, India;
| | - Sairu Philip
- Department of Community Medicine, Government Medical College, Kottayam 686008, India;
| | - Tanu Anand
- Scientist E, Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi 110029, India;
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India;
| | - Farzana Islam
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi 110062, India;
| | - Neeta Singla
- Department of Training, National Institute of TB & Respiratory Disease, New Delhi 110030, India;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France;
| | | | - BK Vashishat
- State TB Cell, Gulabi Bagh, New Delhi 110007, India;
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Otero L, Zetola N, Campos M, Zunt J, Bayer A, Curisinche M, Ochoa T, Reyes M, Vega V, Van der Stuyft P, Sterling TR. Isoniazid preventive therapy completion in children under 5 years old who are contacts of tuberculosis cases in Lima, Peru: study protocol for an open-label, cluster-randomized superiority trial. Trials 2023; 24:54. [PMID: 36694242 PMCID: PMC9871424 DOI: 10.1186/s13063-022-07062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Children < 5 years old in contact with TB cases are at high risk for developing severe and fatal forms of TB. Contact investigation, BCG vaccination, and isoniazid preventive therapy (IPT) are the most effective strategies to prevent TB among children. However, the implementation of IPT faces challenges at several stages of the cascade of care of TB infection among children, particularly those less than 5 years old. In Peru, a large proportion of children do not complete IPT, which highlights the need to design effective interventions that enhance preventive therapy adherence and completion. Although the body of evidence for such interventions has grown, interventions in medium TB incidence settings are lacking. This study aims to test the effectiveness, acceptability, and feasibility of an intervention package to increase information and motivation to complete IPT among children < 5 who have been prescribed IPT. METHODS An open-label, cluster-randomized superiority trial will be conducted in two districts in South Lima, Peru. Thirty health facilities will be randomized as clusters, 10 to the intervention and 20 to control (standard of care). We aim to recruit 10 children from different households in each cluster. Participants will be caretakers of children aged < 5 years old who initiated IPT. The intervention consists of educational material, and short message services (SMS) reminders and motivators. The primary outcomes will be the proportion of children who picked up > 90% of the 24 weeks of IPT (22 pick-ups) and the proportion of children who picked up the 24 weeks of IPT. The standard of care is a weekly pick-up with monthly check-ups in a health facility. Feasibility and acceptability of the intervention will be assessed through an interview with the caretaker. DISCUSSION Unfavorable outcomes of TB in young children, high effectiveness of IPT, and low rates of IPT completion highlight the need to enhance adherence and completion of IPT among children < 5 years old. Testing of a context-adapted intervention is needed to improve IPT completion rates and therefore TB prevention in young children. TRIAL REGISTRATION ClinicalTrials.gov NCT03881228. Registered on March 19, 2019.
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Affiliation(s)
- L. Otero
- grid.11100.310000 0001 0673 9488Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru ,grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru ,grid.11505.300000 0001 2153 5088Unit of General Epidemiology and Disease Control, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - N. Zetola
- grid.410427.40000 0001 2284 9329Division of Pulmonary and Critical Care, Augusta University, Augusta, GA USA
| | - M. Campos
- grid.11100.310000 0001 0673 9488Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru ,grid.11100.310000 0001 0673 9488Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Zunt
- grid.34477.330000000122986657Department of Neurology, University of Washington School of Medicine, WA Seattle, USA
| | - A. Bayer
- grid.11100.310000 0001 0673 9488Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M. Curisinche
- grid.419858.90000 0004 0371 3700Dirección de Prevención Y Control de Tuberculosis, Ministerio de Salud, Lima, Peru ,grid.419228.40000 0004 0636 549XCentro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
| | - T. Ochoa
- grid.11100.310000 0001 0673 9488Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru ,grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M. Reyes
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - V. Vega
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - P. Van der Stuyft
- grid.5342.00000 0001 2069 7798Department of Public Health, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - TR. Sterling
- grid.152326.10000 0001 2264 7217Vanderbilt University School of Medicine, Nashville, TN USA
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Zeladita-Huaman J, Yuen CM, Zegarra-Chapoñan R, Curisinche-Rojas M, Egusquiza-Pozo V. Caregivers' knowledge and perceptions are associated with children's TB preventive treatment completion. Public Health Action 2021; 11:85-90. [PMID: 34159068 PMCID: PMC8202630 DOI: 10.5588/pha.21.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Forty-six health centers in south Lima, Peru. OBJECTIVE To assess the association between caregivers' knowledge and perceptions around isoniazid preventive therapy (IPT) and whether their children complete IPT. DESIGN We conducted a retrospective medical record review of children who initiated IPT during 2017-2018. We administered structured surveys to caregivers of the children about their knowledge about and perceptions of IPT. We used a modified Poisson regression to determine factors associated with IPT completion. RESULTS We included 550 children, of whom 31% did not complete IPT. Independent factors associated with not completing IPT were low caregiver knowledge about TB and IPT (adjusted risk ratio [aRR] 1.41, 95% CI 1.06-1.78), low caregiver perception of the importance of IPT (aRR 1.76, 95% CI 1.30-2.39), low caregiver satisfaction with the health services (aRR 1.57, 95% CI 1.14-2.16), experience of adverse events (aRR 2.08, 95% CI 1.51-2.87), and living in a household with moderate or severe family dysfunction (aRR 1.53, 95% CI 1.07-2.19). CONCLUSION IPT completion among children was associated with the knowledge and perceptions of their caregivers, as well as the experience of adverse events. To improve IPT completion among children, health care providers should prioritize education and counseling for caregivers, promote positive interpersonal relationships with them, and monitor adverse events.
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Affiliation(s)
- J Zeladita-Huaman
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru
| | - C M Yuen
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - R Zegarra-Chapoñan
- Universidad Maria Auxiliadora, Facultad de Ciencias de la Salud, Lima, Peru
| | | | - V Egusquiza-Pozo
- Universidad Maria Auxiliadora, Facultad de Ciencias de la Salud, Lima, Peru
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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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Diaz G, Victoria AM, Meyer AJ, Niño Y, Luna L, Ferro BE, Davis JL. Evaluating the Quality of Tuberculosis Contact Investigation in Cali, Colombia: A Retrospective Cohort Study. Am J Trop Med Hyg 2021; 104:1309-1316. [PMID: 33617470 PMCID: PMC8045602 DOI: 10.4269/ajtmh.20-0809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/10/2020] [Indexed: 11/07/2022] Open
Abstract
Tuberculosis (TB) contact investigation facilitates earlier TB diagnosis and initiation of preventive therapy, but little data exist about the quality of its implementation. We conducted a retrospective cohort study to evaluate processes of TB contact investigation for index TB patients diagnosed in Cali, Colombia, in 2017, including dropout at each stage and overall yield. We constructed multivariable models to identify predictors of completing 1) the baseline household visit and 2) a follow-up clinic visit for TB evaluation among referred contacts. Sixty-eight percent (759/1,120) of registered TB patients were eligible for contact investigation; 77% (582/759) received a household visit. Odds of completing a household visit were significantly lower among men (adjusted odds ratio [aOR]: 0.6; 95% CI: 0.4-0.9; P = 0.009) and patients living in Cali's western zone (aOR: 0.5; 95% CI: 0.3-0.8; P = 0.008). Among 1880 screened contacts, 31% (n = 582) met the criteria for clinic referral, 47% (n = 271) completed a clinic visit, and 85% (231/271) completed testing. After adjusting for clustering by index patient, odds of completing referral were higher among contacts with cough (aOR: 22; 95% CI: 7.1-66; P < 0.001) and contacts living in the western zone (aOR: 4.1; 95% CI: 1.2-15; P = 0.03). The cumulative probability of a symptomatic contact from an eligible household completing TB evaluation was only 28%. The yield of active TB patients among contacts was only 0.3% (5/1880). Only 16% (17/103) of children aged < 5 years were included, and none of the eight persons were living with HIV-initiated preventive therapy. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.
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Affiliation(s)
- Gustavo Diaz
- 1Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.,2Universidad Icesi, Cali, Colombia
| | - Angela María Victoria
- 1Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.,3Departamento de Salud Pública y Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.,4Grupo de investigación en epidemiologia de servicios-Griepis, Facultad de Ciencias de la Salud, Universidad Libre Seccional Cali, Cali, Colombia
| | - Amanda J Meyer
- 5Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Yessenia Niño
- 6Secretaría de Salud Pública Municipal de Santiago de Cali-Programa de Control de Micobacterias, Cali, Colombia.,4Grupo de investigación en epidemiologia de servicios-Griepis, Facultad de Ciencias de la Salud, Universidad Libre Seccional Cali, Cali, Colombia
| | - Lucy Luna
- 6Secretaría de Salud Pública Municipal de Santiago de Cali-Programa de Control de Micobacterias, Cali, Colombia.,4Grupo de investigación en epidemiologia de servicios-Griepis, Facultad de Ciencias de la Salud, Universidad Libre Seccional Cali, Cali, Colombia
| | - Beatriz E Ferro
- 3Departamento de Salud Pública y Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J Lucian Davis
- 5Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.,7Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut.,8Pulmonary, Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut
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7
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Yuen CM, Millones AK, Puma D, Jimenez J, Galea JT, Calderon R, Pages GS, Brooks MB, Lecca L, Nicholson T, Becerra MC, Keshavjee S. Closing delivery gaps in the treatment of tuberculosis infection: Lessons from implementation research in Peru. PLoS One 2021; 16:e0247411. [PMID: 33606824 PMCID: PMC7895363 DOI: 10.1371/journal.pone.0247411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background Targeted testing and treatment of TB infection to prevent disease is a pillar of TB elimination. Despite recent global commitments to greatly expand access to preventive treatment for TB infection, there remains a lack of research on how best to expand preventive treatment programs in settings with high TB burdens. Methods We conducted implementation research in Lima, Peru, around a multifaceted intervention to deliver TB preventive treatment to close contacts of all ages, health care workers, and people in congregate settings. Key interventions included use of the interferon gamma release assay (IGRA), specialist support for generalist physicians at primary-level health facilities, and treatment support by community health workers. We applied a convergent mixed methods approach to evaluate feasibility and acceptability based on a care cascade framework. Findings During April 2019-January 2020, we enrolled 1,002 household contacts, 148 non-household contacts, 107 residents and staff of congregate settings, and 357 health care workers. Cumulative completion of the TB preventive care cascade was 34% for contacts <5 years old, 28% for contacts 5–19 years old, 18% for contacts ≥20 years old, 0% for people in congregate settings, and 4% of health care workers. IGRA testing was acceptable to adults exposed to TB. Preventive treatment was acceptable to contacts, but less acceptable to physicians, who frequently had doubts about prescribing preventive treatment for adults. Community-based treatment support was both acceptable and feasible, and periodic home-visits or calls were identified as facilitators of adherence. Conclusions We attempted to close the gap in TB preventive treatment in Peru by expanding preventive services to adult contacts and other risk groups. While suboptimal, care cascade completion for adult contacts was consistent with what has been observed in high-income settings. The major losses in the care cascade occurred in completing evaluations and having doctors prescribe preventive treatment.
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Affiliation(s)
- Courtney M. Yuen
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Harvard Medical School Center for Global Health Delivery, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | | | | | | | - Jerome T. Galea
- School of Social Work, University of South Florida, Tampa, FL, United States of America
- College of Public Health, University of South Florida, Tampa, FL, United States of America
| | | | | | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Harvard Medical School Center for Global Health Delivery, Harvard Medical School, Boston, MA, United States of America
| | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Socios En Salud Sucursal Perú, Lima, Peru
| | - Tom Nicholson
- Duke Center for International Development, Sanford School of Public Policy, Duke University, Durham, NC, United States of America
- Advance Access & Delivery, Durham, NC, United States of America
| | - Mercedes C. Becerra
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Harvard Medical School Center for Global Health Delivery, Harvard Medical School, Boston, MA, United States of America
- Advance Access & Delivery, Durham, NC, United States of America
| | - Salmaan Keshavjee
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Harvard Medical School Center for Global Health Delivery, Harvard Medical School, Boston, MA, United States of America
- Advance Access & Delivery, Durham, NC, United States of America
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8
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Wong M, Coit JM, Mendoza M, Chiang SS, Marin H, Galea JT, Lecca L, Franke MF. Incident Tuberculosis Diagnoses in Children at High Risk for Disease. Open Forum Infect Dis 2021; 8:ofab075. [PMID: 33738322 PMCID: PMC7953651 DOI: 10.1093/ofid/ofab075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
We followed 35 children meeting a research definition for unconfirmed tuberculosis (TB) but in whom a pediatric pulmonologist did not diagnose or treat TB. After a median follow-up of 16.4 months, most children were not diagnosed with TB following a comprehensive evaluation. However, 2 were diagnosed with TB, demonstrating high TB risk (6%; exact 95% CI, 1%–19%). In some contexts, researchers may wish to supplement these research definitions with clinical decision data and longitudinal follow-up in order to improve specificity.
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Affiliation(s)
| | - Julia M Coit
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Silvia S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | | | - Jerome T Galea
- School of Social Work, University of South Florida, Tampa, Florida, USA.,College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Leonid Lecca
- Socios En Salud Sucursal Peru, Lima, Peru.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Yuen CM, Millones AK, Galea JT, Puma D, Jimenez J, Lecca L, Becerra MC, Keshavjee S. Toward patient-centered tuberculosis preventive treatment: preferences for regimens and formulations in Lima, Peru. BMC Public Health 2021; 21:121. [PMID: 33430823 PMCID: PMC7802335 DOI: 10.1186/s12889-020-10098-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/20/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To ensure patient-centered tuberculosis preventive treatment, it is important to consider factors that make it easier for patients to complete treatment. However, there is little published literature about patient preferences for different preventive treatment regimen options, particularly from countries with high tuberculosis burdens. METHODS We conducted a qualitative research study using a framework analysis approach to understand tuberculosis preventive treatment preferences among household contacts. We conducted three focus group discussions with 16 members of families affected by tuberculosis in Lima, Peru. Participants were asked to vote for preferred preventive treatment regimens and discuss the reasons behind their choices. Coding followed a deductive approach based on prior research, with data-driven codes added. RESULTS In total, 7 (44%) participants voted for 3 months isoniazid and rifapentine, 4 (25%) chose 3 months isoniazid and rifampicin, 3 (19%) chose 4 months rifampicin, and 2 (13%) chose 6 months isoniazid. Preferences for shorter regimens over 6 months of isoniazid were driven by concerns over "getting tired" or "getting bored" of taking medications, the difficulty of remembering to take medications, side effects, and interference with daily life. For some, weekly dosing was perceived as being easier to remember and less disruptive, leading to a preference for 3 months isoniazid and rifapentine, which is dosed weekly. However, among caregivers, having a child-friendly formulation was more important than regimen duration. Caregivers reported difficulty in administering pills to children, and preferred treatments available as syrup or dispersible formulations. CONCLUSIONS There is demand for shorter regimens and child-friendly formulations for tuberculosis preventive treatment in high-burden settings. Individual preferences differ, suggesting that patient-centered care would best be supported by having multiple shorter regimens available.
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Affiliation(s)
- Courtney M Yuen
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Jerome T Galea
- School of Social Work, University of South Florida, Tampa, FL, USA.,College of Public Health, University of South Florida, Tampa, FL, USA
| | | | | | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Socios En Salud Sucursal Perú, Lima, Peru
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Salmaan Keshavjee
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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