Age-specific effectiveness of a tuberculosis screening intervention in children

Abstract

Objective To apply a cascade-of-care framework to evaluate the effectiveness—by age of the child—of an intensified tuberculosis patient-finding intervention. Design From a prospective screening program at four hospitals in Pakistan (2014–2016) we constructed a care cascade comprising six steps: screened, positive screen, evaluated, diagnosed, started treatment, and successful outcome. We evaluated the cascade by each year of age from 0 to 14 and report the age-specific mean proportion and standard deviation. Results On average across all ages, only 12.5% (standard deviation: 2.0%) of children with a positive screen were not evaluated. Among children who had a complete evaluation, the highest percentages of children diagnosed with tuberculosis were observed in children 0–4 (mean: 31.9%; standard deviation: 4.8%), followed by lower percentages in children 5–9 (mean: 22.4%; standard deviation: 2.2%), and 10–14 (mean: 26.0%; standard deviation:5.4%). Nearly all children diagnosed with tuberculosis initiated treatment, and an average of 93.3% (standard deviation: 3.3%) across all ages had successful treatment outcomes. Conclusions This intervention was highly effective across ages 0–14 years. Our study illustrates the utility of applying operational analyses of age-stratified cascades to identify age-specific gaps in pediatric tuberculosis care that can guide future, novel interventions to close these gaps.

Treatment of Infection as a Core Strategy to Prevent Rifampicin-Resistant/Multidrug-Resistant Tuberculosis

“…For both drug-susceptible and RR/MDR M.tb infection treatment, the first step is ruling out active TB disease. This is usually conducted through a symptom assessment, weight monitoring, physical examination, bacteriologic testing, and chest radiography [ 27 ]. Tests for M.tb infection perform poorly as they require a functioning immune system and are, thus, more likely to yield false-negative results in the populations most at risk of becoming sick with TB, such as in young children or persons living with HIV [ 28 ].…”

Screening for Tuberculosis Disease Among Children: A Systematic Review

“…Four studies included in this systematic review indicated that the TST and IGRA tests were utilized as the first screening in paediatric patients with probable tuberculosis. Brooke et al 14 emphasized a history of symptoms suggestive of tuberculosis as initial screening, such with a TB patient in the previous two years and symptoms such as swollen glands, cough for more than two weeks, fever for more than two weeks, sweating, and unexplained weight loss. Four more studies compared the TST test and the IGRA test as screening tools and discovered that the TST test was more successful in terms of accuracy and cost effectiveness.…”

“…The program depended mainly on clinical TB diagnosis and sputum samples. This emphasizes the relevance of TB history, physical examination, contact and exposure history, and chest X-ray findings in diagnosing children with TB, as well as the need for more accurate clinical prediction techniques 19. According to other research, aside from taking a past medical history, further procedures such as TST and IGRA tests are required for TB screening.…”

Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children

“…Elsewhere, we describe details of the screening procedures used. [8][9][10] Children received a clinical evaluation, including chest radiograph, complete blood count and erythrocyte sedimentation rate, and-if they could produce sputum-additional testing such as Xpert MTB/RIF assay and acid fast bacilli smear. If indicated, abdominal ultrasound, computed tomography and/or fine-needle aspiration/biopsy were performed.…”