Nicole Salazar-Austin1,2, Minja Milovanovic3, Nora S West4, Molefi Tladi3, Grace Link Barnes5, Ebrahim Variava3,6, Neil Martinson3,5, Richard E Chaisson5, Deanna Kerrigan7. 1. Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street Room 3147, Baltimore, MD, 21287, USA. nsalaza1@jhmi.edu. 2. Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA. nsalaza1@jhmi.edu. 3. Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Johannesburg, South Africa. 4. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 5. Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 6. Department of Internal Medicine, Klerksdorp/Tshepong Hospital Complex, North West Province Department of Health, Klerksdorp, South Africa and University of the Witwatersrand, Johannesburg, South Africa. 7. Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Abstract
BACKGROUND: Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. METHODS: Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants' experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. RESULTS: Participants' had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. CONCLUSIONS: Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. TRIAL REGISTRATION: The results presented here were from research related to NCT03074799 , retrospectively registered on 9 March 2017.
BACKGROUND: Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. METHODS: Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants' experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. RESULTS: Participants' had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. CONCLUSIONS: Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. TRIAL REGISTRATION: The results presented here were from research related to NCT03074799 , retrospectively registered on 9 March 2017.
Authors: Peter J Dodd; Courtney M Yuen; Charalambos Sismanidis; James A Seddon; Helen E Jenkins Journal: Lancet Glob Health Date: 2017-09 Impact factor: 26.763
Authors: Peter J Dodd; Courtney M Yuen; Mercedes C Becerra; Paul Revill; Helen E Jenkins; James A Seddon Journal: Lancet Glob Health Date: 2018-09-25 Impact factor: 26.763