Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens

Cruz, Andrea T.; Starke, Jeffrey R.

doi:10.1542/peds.2017-2838

Cited by 37 publications

(41 citation statements)

References 16 publications

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“…While treatment of M.tb infection is relatively safe, adverse events do occur. 36 Risk factors for progression include recent exposure, any degree of immunosuppression, 37 especially HIV; 38 low body mass index; 39 and a positive IGRA or TST. 40 The World Health Organization (WHO) now recommends that testing and treatment for M.tb infection can be offered to all close contacts of people with bacteriologically confirmed pulmonary tuberculosis, regardless of their age or HIV status.…”

Section: Mtb Infectionmentioning

confidence: 99%

“…46 Compared to nine-month regimens, shorter regimens are associated with improved adherence -a particular issue in adolescents 47 -and at least equivalent efficacy, with no increase in adverse events. 36,45 Tuberculosis prevention has been historically neglected in high tuberculosis burden settings due to resource constraints. 47 The Sustainable Development Goals place new emphasis on prevention, as demonstrated in both the End TB Strategy 48 and in the WHO/UNICEF Roadmap Towards Ending Tuberculosis in Children and Adolescents.…”

Section: Mtb Infectionmentioning

confidence: 99%

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Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

125

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Adolescence is characterised by a dramatic increase in the incidence of tuberculosis, a fact that has been appreciated since the early 20 th century. The majority of the world's adolescents live in low and middle-income countries where tuberculosis remains common, and where they comprise one quarter of the population. Despite this, adolescents have not yet been addressed as a distinct population in tuberculosis policy or within tuberculosis treatment services, and emerging evidence suggests that current models of care do not meet their needs.This article reviews current knowledge about tuberculosis in adolescence with a focus on the management of infection and disease, including HIV co-infection and rifampicin-resistant tuberculosis. Recent progress in vaccine development is outlined and important directions for future research are highlighted. Search strategy and selection criteriaThis was a narrative review of the literature on adolescent tuberculosis, informed by expert opinion and clinical experience. We reviewed the English-and Spanish-language literature for studies on adolescent tuberculosis to identify case series documenting clinical presentation and treatment outcomes. We searched PubMed with the following string on 19August 2019: ('tuberculosis'[Title]) AND ('adolescent'[TIAB]). The search returned 210 results, of which 11 were eligible for inclusion (Table 1), and we identified three additional studies from reference lists, for a total of 14 studies. Studies reporting solely on prevalence or where data from adolescents was aggregated with those of younger children or adults were excluded. Data were extracted regarding major site(s) of disease, percent of adolescents with microbiologic confirmation, adverse drug reactions, and final treatment outcomes.

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Section: Mtb Infectionmentioning

confidence: 99%

Section: Mtb Infectionmentioning

confidence: 99%

Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

125

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“…Prior studies have shown that up to 50% of children do not begin or complete isoniazid therapy for TB infection when children or other family members administer the drug ( 5 , 12 , 13 ). In contrast, families of TB-exposed children felt comfortable directly observing the administration of medication to their young, asymptomatic children who had unremarkable examination findings and chest radiograph results and negative tests of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Given the safety profile of TB medications in children ( 4 , 5 ) and the risk for serious disease rapidly developing, treatment during this window is considered highly beneficial for young children. However, although window prophylaxis has been used for decades, its safety and effectiveness have not been assessed.…”

mentioning

confidence: 99%

Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007–2017

Cruz¹,

Starke²

2019

Emerg. Infect. Dis.

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In this retrospective study, we assessed the safety of window period prophylaxis and proportion of tuberculin skin test (TST) conversions in children <5 years of age who were exposed to an adult with tuberculosis disease during 2007–2017. Children included in this study had unremarkable examination and chest radiograph findings and negative test results for TB infection. In total, 752 children (41% cohabitating with the index patient) received prophylaxis during the window period, usually directly observed therapy with isoniazid. Hepatotoxicity and tuberculosis disease did not develop in any child. TST conversion occurred in 37 (4.9%) children and was associated with the index patient being the child’s parent (odds ratio 3.2, 95% CI 1.2–8.2). TST conversion was not associated with sputum smear results, culture positivity, or cohabitation. Thresholds for initiation of window prophylaxis in exposed young children should be low given the safety of medication and difficulties with risk stratification.

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“…In addition, the recent WHO recommendations (4) that include shorter TPT combination regimens (isoniazid and rifampicin or rifapentine for 3 months) are associated with improved adherence compared to the standard TPT regimen of isoniazid monotherapy for at least 6 months and provide an important opportunity for increasing completion of TPT (9,26). (27). Further, follow-up of children receiving TPT at the household could further improve TPT completion rates, and could be easily integrated with activities to support treatment of TB disease of the index cases in the household.…”

mentioning

confidence: 99%

Community Intervention for Child Tuberculosis Active Contact Investigation and Management: Study Protocol for A Cluster Randomized Trial

Vasiliù¹,

Eymard-Duvernay²,

Tchounga³

et al. 2020

Preprint

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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 cluster-randomized 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 heath care 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 contact 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. 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 high low resource high-burden settings.Trial registration: the study has been registered on the 6th of February 2019 on ClinicalTrials.gov with the number NCT03832023 (https://clinicaltrials.gov/ct2/show/NCT03832023?term=CONTACT&cond=Tuberculosis&cntry=UG&draw=2&rank=1 )

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Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens

Abstract: Shorter regimens are associated with increased completion rates and fewer AEs than 9H.

Cited by 37 publications

References 16 publications

Adolescent tuberculosis

Adolescent tuberculosis

Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007–2017

Community Intervention for Child Tuberculosis Active Contact Investigation and Management: Study Protocol for A Cluster Randomized Trial

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