Courtney M Yuen1,2,3, Ana Karina Millones4, Daniela Puma4, Judith Jimenez4, Jerome T Galea5,6, Roger Calderon4, Gabriela S Pages4, Meredith B Brooks2,3, Leonid Lecca2,4, Tom Nicholson7,8, Mercedes C Becerra1,2,3,8, Salmaan Keshavjee1,2,3,8. 1. Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America. 2. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America. 3. Harvard Medical School Center for Global Health Delivery, Harvard Medical School, Boston, MA, United States of America. 4. Socios En Salud Sucursal Perú, Lima, Peru. 5. School of Social Work, University of South Florida, Tampa, FL, United States of America. 6. College of Public Health, University of South Florida, Tampa, FL, United States of America. 7. Duke Center for International Development, Sanford School of Public Policy, Duke University, Durham, NC, United States of America. 8. Advance Access & Delivery, Durham, NC, United States of America.
Abstract
BACKGROUND: Targeted testing and treatment of TB infection to prevent disease is a pillar of TB elimination. Despite recent global commitments to greatly expand access to preventive treatment for TB infection, there remains a lack of research on how best to expand preventive treatment programs in settings with high TB burdens. METHODS: We conducted implementation research in Lima, Peru, around a multifaceted intervention to deliver TB preventive treatment to close contacts of all ages, health care workers, and people in congregate settings. Key interventions included use of the interferon gamma release assay (IGRA), specialist support for generalist physicians at primary-level health facilities, and treatment support by community health workers. We applied a convergent mixed methods approach to evaluate feasibility and acceptability based on a care cascade framework. FINDINGS: During April 2019-January 2020, we enrolled 1,002 household contacts, 148 non-household contacts, 107 residents and staff of congregate settings, and 357 health care workers. Cumulative completion of the TB preventive care cascade was 34% for contacts <5 years old, 28% for contacts 5-19 years old, 18% for contacts ≥20 years old, 0% for people in congregate settings, and 4% of health care workers. IGRA testing was acceptable to adults exposed to TB. Preventive treatment was acceptable to contacts, but less acceptable to physicians, who frequently had doubts about prescribing preventive treatment for adults. Community-based treatment support was both acceptable and feasible, and periodic home-visits or calls were identified as facilitators of adherence. CONCLUSIONS: We attempted to close the gap in TB preventive treatment in Peru by expanding preventive services to adult contacts and other risk groups. While suboptimal, care cascade completion for adult contacts was consistent with what has been observed in high-income settings. The major losses in the care cascade occurred in completing evaluations and having doctors prescribe preventive treatment.
BACKGROUND: Targeted testing and treatment of TB infection to prevent disease is a pillar of TB elimination. Despite recent global commitments to greatly expand access to preventive treatment for TB infection, there remains a lack of research on how best to expand preventive treatment programs in settings with high TB burdens. METHODS: We conducted implementation research in Lima, Peru, around a multifaceted intervention to deliver TB preventive treatment to close contacts of all ages, health care workers, and people in congregate settings. Key interventions included use of the interferon gamma release assay (IGRA), specialist support for generalist physicians at primary-level health facilities, and treatment support by community health workers. We applied a convergent mixed methods approach to evaluate feasibility and acceptability based on a care cascade framework. FINDINGS: During April 2019-January 2020, we enrolled 1,002 household contacts, 148 non-household contacts, 107 residents and staff of congregate settings, and 357 health care workers. Cumulative completion of the TB preventive care cascade was 34% for contacts <5 years old, 28% for contacts 5-19 years old, 18% for contacts ≥20 years old, 0% for people in congregate settings, and 4% of health care workers. IGRA testing was acceptable to adults exposed to TB. Preventive treatment was acceptable to contacts, but less acceptable to physicians, who frequently had doubts about prescribing preventive treatment for adults. Community-based treatment support was both acceptable and feasible, and periodic home-visits or calls were identified as facilitators of adherence. CONCLUSIONS: We attempted to close the gap in TB preventive treatment in Peru by expanding preventive services to adult contacts and other risk groups. While suboptimal, care cascade completion for adult contacts was consistent with what has been observed in high-income settings. The major losses in the care cascade occurred in completing evaluations and having doctors prescribe preventive treatment.
Authors: Meredith B Brooks; Ana Karina Millones; Daniela Puma; Carmen Contreras; Judith Jimenez; Christine Tzelios; Helen E Jenkins; Courtney M Yuen; Salmaan Keshavjee; Leonid Lecca; Mercedes C Becerra Journal: PLoS One Date: 2022-03-24 Impact factor: 3.240