A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking

Abstract

Background and objectivesIdentifying and treating children with latent tuberculosis infection (TB infection) is critical to prevent progression to TB disease and to eliminate TB globally. Diagnosis and treatment of TB infection requires completion of a sequence of steps, collectively termed the TB infection care cascade. There has been no systematic attempt to comprehensively summarise literature on the paediatric TB infection care cascade.MethodsWe performed a scoping review of the paediatric TB infection care cascade. We systematically searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane and Embase databases. We reviewed articles and meeting abstracts that included children and adolescents ≤21 years old who were screened for or diagnosed with TB infection, and which described completion of at least one step of the cascade. We synthesised studies to identify facilitators and barriers to retention, interventions to mitigate attrition and knowledge gaps.ResultsWe identified 146 studies examining steps in the paediatric TB infection care cascade; 31 included children living in low-income and middle-income countries. Most literature described the final cascade step (treatment initiation to completion). Studies identified an array of patient and caregiver-related factors associated with completion of cascade steps. Few health systems factors were evaluated as potential predictors of completion, and few interventions to improve retention were specifically tested.ConclusionsWe identified strengths and gaps in the literature describing the paediatric TB infection care cascade. Future research should examine cascade steps upstream of treatment initiation and focus on identification and testing of at-risk paediatric patients. Additionally, future studies should focus on modifiable health systems factors associated with attrition and may benefit from use of behavioural theory and implementation science methods to improve retention.

Child Contact Case Management—A Major Policy-Practice Gap in High-Burden Countries

“…Despite supportive evidence and existing WHO and national-level recommendations for CCM, many barriers still exist to their implementation. Recent systematic reviews have identified key challenges for CCM implementation and delivery of TPT, which include knowledge, attitudes, fear of stigma, poor access to tuberculin skin test (TST) and interferon gamma release assay (IGRA) for TB infection identification, poor access to chest radiography (CXR) to rule out active TB disease before TPT initiation, competing priorities for parents, and long treatment regimens affecting treatment adherence [10][11][12]. The impact of interventions deployed to overcome some of these challenges was summarized in an additional systematic review [13].…”

Isoniazid preventive therapy completion in children under 5 years old who are contacts of tuberculosis cases in Lima, Peru: study protocol for an open-label, cluster-randomized superiority trial

“…When evaluating why do children not complete TPT, a scoping review of 146 studies identified concerns about adverse effects, low income, stigma, and transport as barriers and found these factors to be associated with lower retention in care [ 16 ]. Conversely, caregiver education and shorter regimens facilitated the completion of TPT [ 16 ].…”

“…When evaluating why do children not complete TPT, a scoping review of 146 studies identified concerns about adverse effects, low income, stigma, and transport as barriers and found these factors to be associated with lower retention in care [ 16 ]. Conversely, caregiver education and shorter regimens facilitated the completion of TPT [ 16 ]. Health system aspects such as poor linkage to TB services, patient’s mistrust of the health system, and lack of commitment to shared responsibility on TPT adherence by providers impacted treatment initiation, adherence, and completion in both adults and children on TPT [ 12 ].…”

“…There is limited evidence on the effectiveness of interventions to improve adherence to and completion of IPT and other TPT, especially in high and moderate TB incidence settings [ 18 , 19 ]. For every 10 intervention studies in high-income countries (HIC), there is one in low- or middle-income countries (LMIC) [ 16 , 20 ]. Education, counseling, incentives (monetary and non-monetary) and cultural case management may be effective for IPT completion, but results vary by context and underlying reasons for poor adherence [ 20 , 21 ].…”

Challenges Perceived by Health Care Providers for Implementation of Contact Screening and Isoniazid Chemoprophylaxis in Karnataka, India

“…A scoping review from Campbell et al highlighted the fact that a well-defined cascade of care is not being followed for systematic evaluation of pediatric latent TB infection. Most of the studies have focused on the aspect of treatment initiation and completion, while the other components such as screening, investigation, and not initiating TB preventive treatment are given lesser importance [ 8 ].…”