A public health approach to increase treatment of latent TB among household contacts in Brazil

Abstract

SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI – 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.

Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation.

“…The intervention trial consisted of a rapid public health evaluation to identify barriers to LTBI treatment for HHC of index-TB patients, followed by site speci c selection of strengthening activities and implementation of interventions to the barriers. (9) In Rio de Janeiro, Brazil, LTBI program strengthening interventions consisted of: (i) initial training of HCWs by a TB physician covering all steps of the LTBI cascade of care, (ii) intensi ed in-service training of HCWs provided by an infectious disease physician (weekly visits for the rst two months, then every two weeks for two months, then once a month), (iii) development and use of a contact registry to facilitate a cascade analysis to support the in-service training of HCWs, (iv) lea ets with educational information for index-TB patients and their contacts and (v) educational material developed for health care workers (TB booklet). (9) After October 2018, all trial interventions were stopped.…”

“…(9) In Rio de Janeiro, Brazil, LTBI program strengthening interventions consisted of: (i) initial training of HCWs by a TB physician covering all steps of the LTBI cascade of care, (ii) intensi ed in-service training of HCWs provided by an infectious disease physician (weekly visits for the rst two months, then every two weeks for two months, then once a month), (iii) development and use of a contact registry to facilitate a cascade analysis to support the in-service training of HCWs, (iv) lea ets with educational information for index-TB patients and their contacts and (v) educational material developed for health care workers (TB booklet). (9) After October 2018, all trial interventions were stopped. This meant cessation of in-service training, provision of lea ets to HHC and index patients, and no further on-site visits by research staff.…”

“…In a preceding trial (ACT4), ( 8) interventions were implemented to strengthen key steps in the LTBI cascade of care with the goal of increasing the number of HHC initiating LTBI treatment in Brazil. (9) The primary objective of this follow-up study was to compare the number of HHC identi ed and initiating LTBI treatment after the trial interventions had ceased to the number identi ed and initiating LTBI treatment before the trial and during the intervention phase of the trial.…”

Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation.

“…9In Rio de Janeiro, Brazil, LTBI program strengthening interventions consisted of: (i) initial training of HCWs by a TB physician covering all steps of the LTBI cascade of care, (ii) intensi ed in-service training of HCWs provided by an infectious disease physician (weekly visits for the rst two months, then every two weeks for two months, then once a month), (iii) development and use of a contact registry to facilitate a cascade analysis to support the in-service training of HCWs, (iv) lea ets with educational information for index-TB patients and their contacts and (v) educational material developed for health care workers (TB booklet). (9) After October 2018, all trial interventions were stopped. This meant cessation of in-service training, provision of lea ets to HHC and index patients, and no further on-site visits by research staff.…”

“…In a preceding trial (ACT4), (8) interventions were implemented to strengthen key steps in the LTBI cascade of care with the goal of increasing the number of HHC initiating LTBI treatment in Brazil. (9) The primary objective of this follow-up study was to compare the number of HHC identi ed and initiating LTBI treatment after the trial interventions had ceased to the number identi ed and initiating LTBI treatment before the trial and during the intervention phase of the trial.…”