Tuberculosis treatment outcomes among peri-urban children receiving doorstep tuberculosis care

Abstract

Objective To determine the optimal tuberculosis (TB) management strategy for children living in peri-urban, resource-limited settings. Design We compared TB treatment outcomes among children, aged 0–15 years, receiving doorstep care (n=82) to a historical group (n=97) receiving clinic-based care. Results In comparison, the doorstep care and clinic-based groups had similar age and sex profiles; treatment default rates were 3.7% (3/82) vs 38.1% (37/97), p<0.0001; treatment completion rates were 65.9% (54/82) vs 51.6% (50/97), p=0.01; and cure rates were 13.4% (11/82) vs 2.1% (2/97), p<0.0001 respectively. Conclusion Children living within peri-urban communities experience improved TB outcomes with doorstep care.

Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa

“…By deploying GeneXpert MTB/RIF outside of a central site and offering immediate TB treatment initiation outside of the clinic, we attempted to expedite TB case finding in the community. While we found only a small number of TB cases in the intervention arm, TB treatment completion rates in the “Test & Treat TB” strategy were better than completion rates for TB cases diagnosed at clinic level in South Africa (5 of 6, 83%, 95% CI 36%, 100%) [16, 22]. Participants were enrolled prior to their HIV and/or TB test to reduce differential acceptance rates by results of HIV and TB testing, facilitating a representative sample of newly diagnosed individuals.…”

“…GeneXpert-positive participants, regardless of HIV status, were provided: 1) a TB treatment starter pack, a three-week supply of a weight-based, fixed-dose combination of rifampin, isoniazid, pyrazinamide, and ethambutol, as per South African guidelines, dispensed at the mobile tester, and referral to a local clinic with a copy of their GeneXpert MTB/RIF test result to continue treatment [16], 2) SMS reminders at the end of the starter pack and monthly for the duration of TB treatment and 3) three cashless incentives (mobile phone minutes) for a) returning to the mobile unit for positive test results, b) linkage to TB care at a participating clinic (within 3 weeks), and c) TB treatment completion.…”

The costs and outcomes of paediatric tuberculosis treatment at primary healthcare clinics in Johannesburg, South Africa

“…[7] A record review of children (aged 0 -15 years) living in periurban communities found that treatment success was good (79%, 65/82 in 2008 -2011) among patients receiving supervised home visits from trained community caregivers or nurses, but clinic-based treatment showed relatively low rates of success (54%, 52/97 in 2005 -2008) and high rates of loss to follow-up (38%). [8] In comparison, older studies (2003 -2005) of hospital-based treatment in Cape Town reported treatment success of 71% (97/137) in HIV-infected children (aged 0 -11 years), [9] and higher mortality in young children (9%, 31/334, age <3 years) than older children (4%, 10/262, age 4 -13 years), although treatment outcomes were not reported separately from patients who tested positive for drug resistance (11%). [10]…”

Outcomes in children treated for tuberculosis with the new dispersible fixed-dose combinations in Port Moresby

“…3 LTFU and poor treatment adherence are frequent in cohorts of children treated for TB in high-burden settings. 14,15 One of the commonly perceived treatment barriers to adherence, a lack of child-friendly medicines, was not a factor in this cohort and yet retention in care remained a challenge. LFTU also occurred despite the use of incentives.…”

“…Enabling patients to receive care closer to home by enhancing community-based treatment support may be an important factor to promote. 15 The proportion of all bacteriologically confirmed TB in PNG is low (26% of pulmonary TB cases) and the diagnosis of pulmonary TB without sputum or of extrapulmonary TB is common. 3 The low rate of bacteriological confirmation (less than 1%) underlines the challenges of TB diagnosis in children.…”