Determinants of losses in the latent tuberculosis infection cascade of care in Brazil.

Autor:	Souza AB; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Manaus, AM, Brazil., Arriaga MB; Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil., Amorim G; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA., Araújo-Pereira M; Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil., Nogueira BMF; Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.; Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, BA, Brazil., Queiroz ATL; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.; Center of Data and Knowledge Integration for Health (CIDACS),Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil., Figueiredo MC; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA., Rocha MS; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.; Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, BA, Brazil., Benjamin A; Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil., Moreira ASR; Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Oliveira JG; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil., Rolla V; Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil., Durovni B; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil., Lapa E Silva JR; Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Kritski AL; Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Cavalcante S; Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil.; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil., Sterling T; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA., Andrade BB; Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA., Cordeiro-Santos M; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil marcelocordeiro.br@gmail.com.; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Manaus, AM, Brazil.; Faculdade de Medicina, Universidade Nilton Lins, Manaus, AM, Brazil.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2021 Sep; Vol. 6 (9).
DOI:	10.1136/bmjgh-2021-005969
Abstrakt:	Introduction: Factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil. Methods: Close contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6-24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade. Results: Among 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/ pardo (brown) race were independently associated with losses in the cascade. Conclusion: There were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil. Competing Interests: Competing interests: The funders of the study had no role in study design, data analysis, data interpretation, or writing of the report. All authors had access to all the data in the study and had final responsibility for the decision to submit for publication. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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