Strategies to increase childhood tuberculosis case detection at the primary health care level: Lessons from an active case finding study in Zambia.

Autor: Kagujje M; Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia., Nyangu S; Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia., Maimbolwa MM; Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia., Shuma B; Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia., Mutti L; Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia., Somwe P; Strategic Information Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia., Sanjase N; Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia., Chungu C; Programs, Catholic Relief Services, Lusaka, Zambia., Kerkhoff AD; Department of Medicine, University of San Francisco California, San Francisco, California, United States of America., Muyoyeta M; Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Jul 19; Vol. 18 (7), pp. e0288643. Date of Electronic Publication: 2023 Jul 19 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0288643
Abstrakt: Introduction: In high TB burden settings, it is estimated that 10-20% of total notifications should be children, however, currently only 6-8% of the total TB notifications in Zambia are children. We assessed whether the implementation of a multicomponent strategy, at primary healthcare facilities, that systematically targets barriers at each step of the childhood TB diagnostic cascade can increase childhood TB case detection.
Methods: We conducted a controlled, interrupted time series analysis to compare childhood TB case notifications before (January 2018-December 2019), and during implementation (January 2020-September 2021) in two intervention and two control Level 1 hospitals in Lusaka, Zambia. At each of the intervention facilities, we implemented a multicomponent strategy constituting: (1) capacity development on childhood TB and interpretation of chest x-ray, (2) TB awareness-raising and demand creation activities, (3) setting up fast track TB services, (4) strengthening of household contact tracing, and (5) improving access to digital chest X-ray for TB screening and Xpert MTB/Rif Ultra for TB diagnosis, through strengthening sample collection in children.
Findings: Among 5,150 children < 15 years screened at the two intervention facilities during the study period, 503 (9.8% yield) were diagnosed with TB. Of these, 433 (86.1%) were identified through facility-based activities (10.5% yield) and 70 (13.9%) were identified through household contact tracing (6.9% yield). Overall, 446 children (88.7%) children with TB were clinically diagnosed. Following implementation of the multicomponent strategy, the proportion children contributed to total TB notifications immediately changed by +1.5% (95%CI: -3.5, 6.6) and -4.4% (95%CI: -7.5, 1.4) at the intervention and control sites, respectively (difference 6.0% [95%CI: -0.7, 12.7]), p = 0.08); the proportion of childhood notifications increased 0.9% (95%CI: -0.7, 2.5%) each quarter at the intervention sites relative to pre-implementation trends, while declining 1.2% (-95%CI: -1.8, -0.6) at the control sites (difference 2.1% [95%CI: 0.1, 4.2] per quarter between, p = 0.046); this translated into 352 additional and 85 fewer childhood TB notifications at the intervention and control sites, respectively, compared to the pre-implementation period.
Conclusion: A standardized package of strategies to improve childhood TB detection at primary healthcare facilities was feasible to implement and was associated with a sustained improvement in childhood TB notifications.
Competing Interests: The authors have declared that no competing interests exist
(Copyright: © 2023 Kagujje et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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