Mercedes Yanes-Lane1, Anete Trajman1,2,3, Mayara Lisboa Bastos1,3, Olivia Oxlade1,4, Chantal Valiquette1, Nathalia Rufino5, Federica Fregonese1, Dick Menzies6,7. 1. Research Institute McGill University Health Centre, Montreal, Quebec, Canada. 2. Internal Medicine Graduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 3. Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil. 4. McGill International TB Centre, McGill University, Montreal, Quebec, Canada. 5. Vector Bourne Diseases Department, Oswaldo Cruz Institute, Rio de Janeiro, Brazil. 6. Research Institute McGill University Health Centre, Montreal, Quebec, Canada. dick.menzies@mcgill.ca. 7. McGill International TB Centre, McGill University, Montreal, Quebec, Canada. dick.menzies@mcgill.ca.
Abstract
BACKGROUND: Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives. METHODS: In two health clinics in Rio de Janeiro that received the interventions in the trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. RESULTS: In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, - 15) but the number starting latent TB infection treatment was sustained (difference -2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment. CONCLUSION: In this follow-up study, we observed a sustained effect of interventions to strengthen the latent TB infection cascade of care on increasing the number of household contacts starting latent TB infection treatment.
RCT Entities:
BACKGROUND: Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives. METHODS: In two health clinics in Rio de Janeiro that received the interventions in the trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. RESULTS: In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, - 15) but the number starting latent TB infection treatment was sustained (difference -2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment. CONCLUSION: In this follow-up study, we observed a sustained effect of interventions to strengthen the latent TB infection cascade of care on increasing the number of household contacts starting latent TB infection treatment.
Entities:
Keywords:
Cascade of care; Cluster randomized trial; Health care workers; Household contacts; Latent tuberculosis; Program evaluation; Tuberculosis preventive therapy
Authors: M L Bastos; O Oxlade; A Benedetti; F Fregonese; C Valiquette; S C C Lira; D Carvalho-Cordeiro; J R Cavalcante; E Faerstein; M F M Albuquerque; M Cordeiro-Santos; P C Hill; D Menzies; A Trajman Journal: Int J Tuberc Lung Dis Date: 2020-10-01 Impact factor: 2.373
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Authors: Olivia Oxlade; Anete Trajman; Andrea Benedetti; Mênonli Adjobimey; Victoria J Cook; Dina Fisher; Gregory James Fox; Federica Fregonese; Panji Hadisoemarto; Philip C Hill; James Johnston; Richard Long; Joseph Obeng; Rovina Ruslami; Chantal Valiquette; Dick Menzies Journal: BMJ Open Date: 2019-03-20 Impact factor: 2.692
Authors: Melbourne F Hovell; Katharine E Schmitz; Elaine J Blumberg; Linda Hill; Carol Sipan; Lawrence Friedman Journal: Contemp Clin Trials Commun Date: 2018-08-16