Determinants of losses in the tuberculosis infection cascade of care among children and adolescent contacts of pulmonary tuberculosis cases: A Brazilian multi-centre longitudinal study.

Autor:	Sobral L; Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Brazil.; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil., Arriaga MB; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru., Souza AB; Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil.; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil., Araújo-Pereira M; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil., Barreto-Duarte B; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.; Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Sales C; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil., Rocha MS; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil., Benjamin A; Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil., Moreira ASR; Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., de Oliveira JG; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil., Carvalho AC; Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.; Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Spener-Gomes R; Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil.; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.; Universidade Federal do Amazonas, Manaus, Brazil., Figueiredo MC; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA., Cavalcante S; Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil.; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil., Durovni B; Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.; 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, Brazil., Kritski AL; Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Rolla VC; Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil., Sterling TR; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA., Cordeiro-Santos M; Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil.; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.; Universidade Nilton Lins, Manaus, Brazil., Andrade BB; Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Brazil.; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil.; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Jazyk:	angličtina
Zdroj:	Lancet regional health. Americas [Lancet Reg Health Am] 2022 Nov; Vol. 15. Date of Electronic Publication: 2022 Aug 23.
DOI:	10.1016/j.lana.2022.100358
Abstrakt:	Background: Approximately 10% of the global tuberculosis (TB) burden is in children. Identification, diagnosis, and early treatment of Mycobacterium tuberculosis infection (TBI) is critical to prevent progression to TB in children. The risk of TB, including severe disease, is highest in children <5 years old. We evaluated the cascade of TBI care among child and adolescent TB contacts to identify factors associated with losses in the cascade. Methods: Close contacts ≤ 18 years old of pulmonary TB patients enrolled between 2015 and 2019 in a multi-centre Brazilian cohort were followed for up to 24 months and classified according to age groups: <5 years, 5-9 years, 10-14 years and 15-18 years. Data on clinical investigation, radiographic examination, IGRA testing at baseline and 6 months, initiation and completion of TB preventive treatment (TPT) were collected. Multivariable regression analyses identified factors associated with TBI and losses in the cascade of care in children and adolescents. Findings: Among 1795 TB contacts initially identified, 530 (29·5%) were ≤18 years old. Losses for all steps in the cascade were especially high in children <5 years old (88%) because at this age all contacts are recommended to initiate TPT. As a proportion of all children, completion of TPT was low (between 10% and 13%) in all age-groups. Furthermore, multivariable regression revealed that younger age of contacts and TB index cases who were female, had pulmonary cavities, and persistent cough were independently associated with losses in the cascade of care among persons ≤18 years old. Interpretation: Losses in the TBI cascade were the highest among children <5 years, which was the group at highest risk for TB among the four age groups. The findings highlight the need to improve screening, initiation, and completion of TPT of young children who are close contacts of people with TB in Brazil. Funding: National Institutes of Allergy and Infectious Diseases. Competing Interests: Declaration of interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All other authors declare no competing interests.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu