Decentralisation of child tuberculosis services increases case finding and uptake of preventive therapy in Uganda

Zawedde‐Muyanja, Stella; Nakanwagi, A; Dongo, J P; Sekadde, Moorine Penninah; Nyinoburyo, R; Ssentongo, G; Detjen, Anne; Mugabe, Frank; Nakawesi, Jane; Karamagi, Yvonne; Amuge, Pauline; Kekitiinwa, Adeodata; Graham, Stephen M.

doi:10.5588/ijtld.18.0025

Cited by 61 publications

(62 citation statements)

References 17 publications

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“…Furthermore, ruling out TB in young children, especially in those <2 years old – the age group at highest risk of developing TB after exposure – involves recognition of warning signs and symptoms by parents and physicians, including the revision of growth charts These are not routinely recorded in TB contact investigation, hampering follow‐up. Training primary care staff on paediatric TB screening and diagnosis, strengthening communication between referral and primary care facilities, and designing forms to facilitate the appropriate recording and follow‐up of contacts may increase TB detection in and provision of preventive treatment to eligible contacts …”

Section: Discussionmentioning

confidence: 99%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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Objective Contacts of pulmonary tuberculosis (TB) cases are at high risk of TB infection and progression to disease. Close and household contacts and those <5 years old have the highest risk. Isoniazid preventive therapy (IPT) can largely prevent TB disease among infected individuals. International and Peruvian recommendations include TB contact investigation and IPT prescription to eligible contacts. We conducted a study in Lima, Peru, to determine the number of close and household contacts who were evaluated, started on IPT, and who completed it, and the factors associated to compliance with national guidelines. Methods We conducted a longitudinal retrospective study including all TB cases diagnosed between January 2015 and July 2016 in 13 health facilities in south Lima. Treatment cards, TB registers and clinical files were reviewed and data on index cases (sex, age, smear status, TB treatment outcome), contact investigation (sex, age, kinship to the index case, evaluations at month 0, 2 and 6) and health facility (number of TB cases notified per year, proportion of TB cases with treatment success) were extracted. We tabulated frequencies of contact evaluation by contact and index case characteristics. To investigate determinants of IPT initiation and completion, we used generalised linear mixed models. Results A total of 2323 contacts were reported by 662 index cases; the median number of contacts per case was four (IQR, 2–5). Evaluation at month 0 was completed by 99.2% (255/257) of contacts <5 and 98.1% (558/569) of contacts aged 5–19 years. Of 191 eligible contacts <5 years old, 70.2% (134) started IPT and 31.4% (42) completed it. Of 395 contacts 5–19 years old, 36.7% (145) started IPT and 32.4% (47) completed it. Factors associated to not starting IPT among contacts <5 years old were being a second‐degree relative to the index case (OR 6.6 95CI% 2.6–16.5), not having received a tuberculin skin test (TST) (OR 3.9 95%CI 1.4–10.8), being contact of a smear‐negative index case (OR 5.5 95%CI 2.0–15.1) and attending a low‐caseload health facility (OR 2.8 95%CI 1.3–6.2). Factors associated to not starting IPT among 5–19 year‐olds were age (OR 13.7 95%CI 5.9–32.0 for 16‐19 vs. 5–7 years old), being a second‐degree relative (OR 3.0 95%CI 1.6–5.6), not having received a TST (OR 5.4, 95%CI 2.5–11.8), being contact of a male index case (OR 2.1 95CI% 1.2–3.5), with smear‐negative TB (OR 1.9 95%CI 1.0–3.6), and attending a high‐caseload health facility (OR 2.1 95%CI 1.2–3.6). Factors associated to not completing IPT, among contacts who started, were not having received a TST (OR 3.4 95%CI 1.5–7.9 for <5 year‐olds, and OR 4.3 95%CI 1.7–10.8 for those 5–19 years old), being contact of an index case with TB treatment outcome other than success (OR 9.3 95%CI 2.6–33.8 for <5 year‐olds and OR 15.3 95%CI 1.9–125.8 for those 5–19 years old), and, only for those 5–19 years old, attending a health facility with high caseload (OR 3.2 95%CI 1.4–7.7) and a health facility with low proportion of TB cases with treatment succ...

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Section: Discussionmentioning

confidence: 99%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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“…A before-and-after implementation study from Uganda evaluated the effect of strengthening diagnosis, treatment, and prevention of paediatric tuberculosis at peripheral health facilities (partnered with household contact tracing). 54 After implementation, a 140% increase in paediatric case notification was recorded, almost entirely driven by health-care facility interventions indicating that healthcare training might be an effective intervention to increase childhood case detection among children with disease who are difficult to find. Lastly, given predominance of community-driven M tuberculosis transmission, certain social settings have been identified as drivers of M tuberculosis transmission in children.…”

Section: A Comprehensive Public Health Strategy: Looking Forwardmentioning

confidence: 99%

Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies

Martínez

Cords

et al. 2019

The Lancet Respiratory Medicine

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Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household. In this Personal View, we focus on accumulating scientific evidence indicating that the majority of

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“…Effective implementation of existing tools will require integrating other health services, especially those for maternal and child health. 99 Health service delivery for the detection and treatment of tuberculosis in children can be successfully decentralised and strengthened, 289 child-friendly formulations for the treatment of infection and disease are available for young children, and the opportunity for the effective implementation of preventive therapy is unprecedented. 100 Tuberculosis screening and management can also be integrated into other services such as perinatal care, HIV clinics, or nutritional rehabilitation centres.…”

Section: What Can Be Done Now To Address Tuberculosis In Children?mentioning

confidence: 99%

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

et al. 2019

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growing political momentum to definitively address tuberculosis, could all make ending the pandemic within a generation more feasible than ever before. Moving forward with bold, comprehensive strategies Globally, the priority must be to deliver person-centred and family-centred services to all individuals with tuberculosis who present to care. This approach means ensuring that high-quality diagnostics, treatment, and prevention modalities are available to all, wherever they seek care. Improving quality of tuberculosis care in the private sector is crucial to end tuberculosis in high incidence countries such as India, the country with the highest tuberculosis burden. Modelling shows that optimising private sector engagement in India could avert 8 million deaths from tuberculosis between 2019 and 2045 (appendix p 3). In high drug-resistant tuberculosis burden countries, access to rapid drug susceptibility testing (DST) and second-line drugs is essential to success. In Moldova, where more than 25% of all tuberculosis cases are drug-resistant, improving access to DST and second-line drugs would reduce mortality from drug-resistant tuberculosis by 44% in the coming generation (appendix p 3). Secondly, tuberculosis programme budgets must increase to enable reaching these people and populations at high risk of tuberculosis. In Kenya, for example, where the proportions of HIV and tuberculosis coinfection are high, scaling up access to both antiretroviral therapy and tuberculosis preventive therapy can help save an additional 3 million lives over the next generation (appendix p 3). However, ultimately, the fight against tuberculosis will not be won unless countries also ensure that everyone, not just high-risk groups, can access essential health Key messages The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer the question of how countries with high-burden tuberculosis and their development partners should target their future investments to ensure that ending tuberculosis is achievable. Invest first to ensure that high quality rapid diagnostics and treatment are provided to all individuals receiving care for tuberculosis, wherever they seek care This priority includes rapid drug susceptibility testing and second-line treatment for resistant forms of tuberculosis. Achieving universal, high-quality person-centred and family-centred care-including sustained improvement in the performance of private sector providers-usually should be the top policy and budget priority. Reach people and populations at high risk for tuberculosis (such as household and other close contacts of people with tuberculosis, and people with HIV) and bring them into care Active case-finding and treatment in high-risk populations demands adequate resources to reach and care for these populations. At the same time, reaching certain high-risk populations, such as people co-infec...

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Decentralisation of child tuberculosis services increases case finding and uptake of preventive therapy in Uganda

Cited by 61 publications

References 17 publications

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

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