Background:
Tuberculosis (TB) remains a significant global health threat, with approximately 10% of the burden occurring in children. Pediatric populations, especially infants under five years of age, face the highest risk of rapid progression to severe disease following exposure. While the “cascade of care” is a known framework to identify gaps in TB management, its specific application to pediatric and adolescent contacts in Brazil to identify where and why losses occur has not been fully delineated.
Abstract:
- Methods: This multi-center longitudinal study followed 530 pediatric close contacts ($\le$18 years) of pulmonary TB cases in Brazil between 2015 and 2019. Participants were stratified into age groups (<5, 5–9, 10–14, and 15–18 years) to evaluate the TBI cascade of care across four stages: initial evaluation, treatment recommendation, initiation, and completion. Multivariable mixed-effects logistic regression identified independent risk factors for cascade losses.
- Results: Total losses in the cascade were alarmingly high (88%) among children under five years old, primarily due to failure to initiate recommended TB preventive treatment (TPT) and missing follow-up IGRA testing. Across all age groups, only 10–13% of all identified contacts successfully completed TPT. Losses were independently associated with younger contact age and characteristics of the TB index case, including female sex, the presence of pulmonary cavities, and persistent cough.
- Conclusion: Severe gaps exist in the pediatric TB cascade of care in Brazil, particularly for the most vulnerable children under five. There is an urgent need to optimize screening protocols and improve TPT initiation and adherence to interrupt transmission and prevent active disease in this high-risk population.
Keywords: Latent tuberculosis; Contact; Pediatric; TBI cascade; Children.
Clique aqui
- Data de Publicação: 23/08/2022
- Autores: Luciana Sobral, María B. Arriaga, Alexandra B.Souza, Mariana Araújo-Pereira, Beatriz Barreto-Duarte, Caio Sales, Michael S. Rocha, Aline Benjamin, Adriana S. R. Moreira, Jamile G. de Oliveira, Anna Cristina Carvalho, Renata Spener-Gomes, Marina C.Figueiredo, Solange Cavalcante, Betina Durovnijm, José R. Lapa-e-Silva, Afrânio L.Kritski, Valeria C. Rolla, Timothy R.Sterling, Marcelo Cordeiro-Santos, Bruno B. Andrade
