Child contact management in high tuberculosis burden countries: A mixed-methods systematic review

Abstract

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children.

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

“…In our study, <5‐year‐old contacts that were second‐degree relatives of index cases and contacts of a smear‐negative index case were less likely to start IPT. This is in line with a systematic review of child contact management that found children who were offspring of the index case and those who slept in the same room of the index case to be more likely to start IPT . The risk of TB transmission is related to contact intensity and infectiousness of the index case, and both health staff and parents may have a lower risk perception in such instances.…”

“Symptom Screening is Easier, but You Can Miss…”: Perceptions of Nurse-led Symptom-based Screening to Promote Tuberculosis Preventive Therapy in the Context of a Cluster Randomized Trial in South Africa

“…Existing literature from South Africa and other settings has documented nurse fatigue with excessive recordkeeping [17][18][19]. Furthermore, a recent systematic review examining child TB contact management in high burden settings found a lack of tools to support documentation was a common barrier to successful management of child TB contacts [20]. Our ndings suggest the provision of simple tools that are designed with nurse buy-in may enhance uptake, and in this instance facilitate the provision of TPT.…”

Provider attitudes about childhood tuberculosis prevention in Lesotho: A qualitative study

“…A limited number of studies have explored provider attitudes regarding TB prevention in children in a high TB burden setting in-depth (13). In this qualitative study, we found interest and commitment among healthcare providers in Lesotho to improve CCM.…”