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.
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.
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肺结核病例的儿童和青少年接触者中结核感染级联护理损失的决定因素：巴西多中心纵向研究。
DOI：
10.1016/j.lana.2022.100358
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Figueiredo
中科院分区：
文献类型：
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作者：
Sobral,Luciana;Arriaga,MaríaB;Souza,AlexandraB;Araújo-Pereira,Mariana;Barreto-Duarte,Beatriz;Sales,Caio;Rocha,MichaelS;Benjamin,Aline;Moreira,AdrianaSR;deOliveira,JamileG;Carvalho,AnnaCristina;Spener-Gomes,Renata;Figueiredo
背景全球结核病（TB）负担的大约10%是儿童。结核分枝杆菌感染（TBI）的识别、诊断和早期治疗对于预防儿童结核病进展至关重要。5岁以下儿童患结核病（包括严重疾病）的风险最高。我们评估了儿童和青少年结核病接触者中TBI护理的级联，以确定与级联中损失相关的因素。Methods 2015年至2019年在多中心巴西队列中招募的≤ 18岁的肺结核患者的密切接触者被随访长达24个月，并根据年龄组进行分类：<5岁、5-9岁、10-14岁和15-18岁。收集基线和6个月时的临床研究、放射学检查、IGRA检测、结核病预防治疗（TPT）的开始和完成情况。多变量回归分析确定了与TBI和儿童和青少年护理级联损失相关的因素。FindingsAmong 1795 TB Contact initial identified，530（29.5%）are ≤18 years old.级联中所有步骤的损失在<5岁的儿童中特别高（88%），因为在这个年龄，所有接触者都被建议开始TPT。在所有年龄组中，完成TPT的儿童所占比例都很低（10%至13%）。此外，多变量回归分析显示，接触者的年龄较小、女性结核指数病例、有肺空洞和持续咳嗽与≤18岁人群的级联护理损失独立相关。研究结果强调，需要改善巴西结核病密切接触者幼儿的TPT筛查、启动和完成。资助美国国立过敏和传染病研究所。
BackgroundApproximately 10% of the global tuberculosis (TB) burden is in children. Identification, diagnosis, and early treatment ofMycobacterium tuberculosisinfection (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.MethodsClose 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.FindingsAmong 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.InterpretationLosses 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.FundingNational Institutes of Allergy and Infectious Diseases.