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Benjumea-Bedoya D, Villegas Arbeláez E, Martínez-Peñaloza D, Beltrán-Arroyave CP, Restrepo Gouzy AV, Marín D, Cadavid Álvarez LM, Molinares B, Montes Zuluaga FN, Pulido Duarte H, Suárez Parra PM, Alzate Ángel JC, Vélez-Parra G, Realpe T, Vásquez Villa M, Ríos Buitrago SY, Puerta Zapata J, Arango García LM, Perea Torres Y, Pérez Doncel N, Arbeláez Montoya MP, Robledo J. Implementation of an integrated care strategy for child contacts of tuberculosis patients: a quasi-experimental study protocol. BMC Pediatr 2023; 23:28. [PMID: 36653768 PMCID: PMC9850583 DOI: 10.1186/s12887-022-03798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/12/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. OBJECTIVE To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. METHODS A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. CLINICALTRIALS gov identifier NCT04331262. DISCUSSION This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.
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Affiliation(s)
- Dione Benjumea-Bedoya
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia ,grid.441797.80000 0004 0418 3449Grupo de Investigación en Salud Familiar y Comunitaria, School of Health Sciences, Corporación Universitaria Remington, Medellín, Colombia ,grid.412881.60000 0000 8882 5269Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Esteban Villegas Arbeláez
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Daniela Martínez-Peñaloza
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Claudia Patricia Beltrán-Arroyave
- grid.412881.60000 0000 8882 5269Grupo Pediaciencias, Medicine School, Universidad de Antioquia, Medellín, Colombia ,Clínica El Rosario, Medellín, Colombia ,Clínica del Prado, Medellín, Colombia
| | | | - Diana Marín
- grid.412249.80000 0004 0487 2295Grupo de Investigación en Salud Pública, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Beatriz Molinares
- grid.413124.10000 0004 1784 5448Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | | | | | - Juan Carlos Alzate Ángel
- grid.412881.60000 0000 8882 5269Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Guillermo Vélez-Parra
- grid.411140.10000 0001 0812 5789Hospital General de Medellín, Professor Universidad CES, Medellín, Colombia
| | - Teresa Realpe
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Marisol Vásquez Villa
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Stefani Yamile Ríos Buitrago
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Jenifer Puerta Zapata
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lisandra María Arango García
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Yesenia Perea Torres
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Natalia Pérez Doncel
- grid.412249.80000 0004 0487 2295School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María Patricia Arbeláez Montoya
- grid.412881.60000 0000 8882 5269Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Jaime Robledo
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas, Universidad Pontificia Bolivariana, Medellín, Colombia
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Benjumea-Bedoya D, Marín DM, Robledo J, Barrera LF, López L, Del Corral H, Ferro BE, Villegas SL, Díaz ML, Rojas CA, García LF, Arbeláez MP. Risk of infection and disease progression in children exposed to tuberculosis at home, Colombia. Colomb Med (Cali) 2019; 50:261-274. [PMID: 32476692 PMCID: PMC7232949 DOI: 10.25100/cm.v50i4.4185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aim: To assess the risk of tuberculosis (infection and disease) in children less than 15 years’ old who are household contacts of pulmonary tuberculosis patients in three Colombian cities (Medellín, Cali, and Popayán). Methods: A cohort of 1,040 children household contacts of 380 adults with smear-positive pulmonary tuberculosis was followed up for 24 months. Study period 2005-2009. Results: Tuberculin skin test was positive (≥10 mm) in 43.7% (95% CI: 39.2-48.2). Tuberculin skin test positivity was associated with age 10-14 years (Prevalence Ratio -PR= 1.43, 95% CI: 1.1-1.9), having a BCG vaccine scar (PR= 1.52, 95% CI: 1.1-2.1), underweight, closer proximity to the index case and exposure time >3 months. The annual risk of infection (tuberculin skin test induration increase of 6 mm or more per year) was 17% (95% CI: 11.8-22.2) and was associated with a bacillary load of the adult index case (Relative Risk -RR= 2.12, 95% CI: 1.0-4.3). The incidence rate of active tuberculosis was 12.4 cases per 1,000 persons-year. Children <5 years without BCG vaccine scar had a greater risk of developing active disease (Hazard Ratio -HR= 6.00, 95% CI: 1.3-28.3) than those with scar (HR= 1.33, 95% CI: 0.5-3.4). The risk of developing active tuberculosis augmented along with the increase from initial tuberculin skin test (tuberculin skin test 5-9 mm HR= 8.55, 95% CI: 2.5-29.2; tuberculin skin test ≥10 mm HR= 8.16, 95% CI: 2.0-32.9). Conclusions: There is a need for prompt interruption of adult-to-children tuberculosis transmission within households. Conducting proper contact investigation and offering chemoprophylaxis to infected children could reduce tuberculosis transmission.
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Affiliation(s)
- Dione Benjumea-Bedoya
- Universidad de Antioquia, Grupo de Epidemiología, Medellín, Colombia.,Corporación Universitaria Remington, Grupo de Investigación en Salud Familiar y Comunitaria, Medellín, Colombia
| | - Diana M Marín
- Universidad de Antioquia, Grupo de Epidemiología, Medellín, Colombia.,Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Jaime Robledo
- Universidad Pontificia Bolivariana, Medellín, Colombia.,Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Luis F Barrera
- Universidad de Antioquia, Grupo de Inmunología Celular e Inmunogenética (GICIG), Medellín, Colombia
| | - Lucelly López
- Universidad de Antioquia, Grupo de Epidemiología, Medellín, Colombia.,Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Helena Del Corral
- Universidad de Antioquia, Grupo de Epidemiología, Medellín, Colombia
| | - Beatriz E Ferro
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.,Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
| | - Sonia L Villegas
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.,Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - María Lilia Díaz
- Universidad del Cauca, Grupo de Inmunología y Enfermedades Infecciosas, Popayán, Colombia
| | - Carlos A Rojas
- Universidad de Antioquia, Grupo de Epidemiología, Medellín, Colombia
| | - Luis F García
- Universidad de Antioquia, Grupo de Inmunología Celular e Inmunogenética (GICIG), Medellín, Colombia
| | - María P Arbeláez
- Universidad de Antioquia, Grupo de Epidemiología, Medellín, Colombia
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Silva G, Pérez F, Marín D. [Tuberculosis in children and adolescents in Ecuador: analysis of reporting, disease characteristics and treatment outcomeTuberculose em crianças e adolescentes no Equador: análise da notificação, características da doença e resultados do tratamento]. Rev Panam Salud Publica 2019; 43:e104. [PMID: 31892930 PMCID: PMC6922074 DOI: 10.26633/rpsp.2019.104] [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: 07/26/2019] [Accepted: 11/01/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To estimate the tuberculosis (TB) burden in children under 15 years of age and to describe the clinical and epidemiological characteristics and the results of the anti-tuberculosis treatment in Ecuador. METHODS A retrospective study was carried out using data from the national TB programm for 2015 and 2016. The rate and percentage of cases of childhood TB were estimated and the disease characteristics and treatment outcome were described according to age categories: 0-4, 5-9 and 10-14 years. RESULTS Of the 10 991 cases of TB diagnosed, 223 (2.03%) were under 15 years of age; depending on the region, this burden ranged from 0 to 5.5%. Of the 223 cases, 213 had their treatment outcome registered and were included in the study; 78 (37%) were younger than 5 years and 147 (69%) had no record of contact screening. Sixty-five (68%) of the adolescents and 40 (51%) of the children under 5 had a diagnosis of pulmonary TB. HIV prevalence was 11.5% in children under 5 and 6.3% in the 10-14 age group. Treatment was succesful in 93% of cases (cure, 36.6%, treatment completed, 56.8%). CONCLUSIONS Ecuador presents a high percentage of under-diagnosis of childhood TB and a lower than expected burden, mainly in children under 5 years of age. The high prevalence of HIV and the lack of adequate systematization of adolescent contact screening suggest the need to consider family-centered strategies that involve training health personnel in the management of pediatric patients, with a focus on the specific needs of each population.
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Affiliation(s)
- Guido Silva
- Ministerio de Salud Pública de EcuadorQuitoEcuadorMinisterio de Salud Pública de Ecuador, Quito, Ecuador.
| | - Freddy Pérez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Diana Marín
- Universidad Pontificia BolivarianaMedellínColombiaUniversidad Pontificia Bolivariana, Medellín, Colombia.
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