Implementation of an active, clinic-based child tuberculosis contact management strategy in western Kenya

Szkwarko, Daria; Owiti, Philip; Buziba, Nathan; Bigelow, Carol; Eaton, Charles B.; Carter, E. J.

doi:10.5588/pha.17.0119

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…*The number of household contacts that are estimated to be eligible for tuberculosis preventive treatment include all children younger than 5 years, and household contacts older than 5 years who are expected to test positive with the tuberculin skin test based on prevalence data collected at sites 16 and published data 17 (average for Canada 0•55, average for all other countries 0•70). phase showed ongoing improvement at sites, compared with the initial cascade analysis (appendix pp [19][20][21][22][23][24][25].…”

Section: Resultsmentioning

confidence: 92%

Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial

Oxlade

Benedetti

Adjobimey

et al. 2021

The Lancet Public Health

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Background Reaching the UN General Assembly High-Level Meeting on Tuberculosis target of providing tuberculosis preventive treatment to at least 30 million people by 2022, including 4 million children under the age of 5 years and 20 million other household contacts, will require major efforts to strengthen health systems. The aim of this study was to evaluate the effectiveness and cost-effectiveness of a health systems intervention to strengthen management for latent tuberculosis infection (LTBI) in household contacts of confirmed tuberculosis cases.Methods ACT4 was a cluster-randomised, open-label trial involving 24 health facilities in Benin, Canada, Ghana, Indonesia, and Vietnam randomly assigned to either a three-phase intervention (LTBI programme evaluation, local decision making, and strengthening activities) or control (standard LTBI care). Tuberculin and isoniazid were provided to control and intervention sites if not routinely available. Randomisation was stratified by country and restricted to ensure balance of index patients with tuberculosis by arm and country. The primary outcome was the number of household contacts who initiated tuberculosis preventive treatment at each health facility within 4 months of the diagnosis of the index case, recorded in the first or last 6 months of our 20-month study. To ease interpretation, this number was standardised per 100 newly diagnosed index patients with tuberculosis. Analysis was by intention to treat. Masking of staff at the coordinating centre and sites was not possible; however, those analysing data were masked to assignment of intervention or control. An economic analysis of the intervention was done in parallel with the trial. ACT4 is registered at ClinicalTrials.gov, NCT02810678.

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Section: Resultsmentioning

confidence: 92%

Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial

Oxlade

Benedetti

Adjobimey

et al. 2021

The Lancet Public Health

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“…At the Academic Model Providing Access to Healthcare (AMPATH) Partnership at Moi Teaching and Referral Hospital in Eldoret, Kenya, a previously described active, clinic-based child contact screening package funded through TB REACH Wave 2 was expanded across 10 sites in western Kenya in 2013 in an effort to improve CCM. 13 Prior to the screening package, fewer than 1% of child contacts identified and documented by healthcare workers (HCWs) in a child contact register underwent clinical review with treatment decisons. 14 In the first year of the screening package, 86% of child contacts were brought in for evaluation and 89% of IPT-eligible child contacts were initiated on the recommended 6 months of IPT.…”

Section: Introductionmentioning

confidence: 99%

“… 14 In the first year of the screening package, 86% of child contacts were brought in for evaluation and 89% of IPT-eligible child contacts were initiated on the recommended 6 months of IPT. 13 …”

Section: Introductionmentioning

confidence: 99%

Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya

et al. 2021

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SettingChildren especially those <5 years of age exposed to pulmonary tuberculosis (TB) are at a high risk of severe TB disease and death. Isoniazid preventive therapy (IPT) has been shown to decrease disease progression by up to 90%. Kenya, a high TB burden country experiences numerous operational challenges that limit implementation of TB preventive services. IPT completion in child contacts is not routinely reported in Kenya.ObjectiveThis study aims to review the child contact management (CCM) cascade and present IPT outcomes across 10 clinics in western Kenya.DesignA retrospective chart review of programmatic data of a TB Reach-funded active, clinic-based CCM strategy.ResultsOf 553 child contacts screened, 231 (42%) were reported symptomatic. 74 (13%) of the child contacts were diagnosed with active TB disease. Of those eligible for IPT, 427 (90%) initiated IPT according to TB REACH project data while 249 (58%) were recorded in the IPT register with 49 (11%) recorded as a transfer to other facilities. Of the 249 recorded in the IPT register, 205 (82%) were documented to complete therapy (48% of project initiation children).ConclusionOur evaluation shows gaps in the routine CCM care cascade related to completeness of documentation that require further programmatic monitoring and evaluation to improve CCM outcomes.

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“…In recent years, active case finding and contact investigations in high-burden settings have taken the place of passive self-presentation to clinics as preferred strategies for identifying children at high risk of developing TB disease. [2][3][4][5][6][7][8] Contact tracing typically incorporates symptom screening followed by a clinical evaluation and specimen collection in symptom-positive contacts; contact investigations may include differentiated care strategies to reduce barriers to screening, testing, treatment, and prevention. [9][10][11] Tests for TB are often not available in high-burden settings, and symptom screening of child TB contacts can additionally determine eligibility for TB preventive therapy (TPT) in lowresource areas.…”

Section: Introductionmentioning

confidence: 99%

Distinct Risk Factors for Clinical and Bacteriologically Confirmed Tuberculosis among Child Household Contacts in a High-Burden Setting

Sandoval

Swamy

Kay³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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The identification and screening of children at high risk of tuberculosis is essential to the control and prevention of child tuberculosis (TB). BUTIMBA, an active case finding and household contact-tracing project implemented between 2013 and 2015 in Eswatini, evaluated 5,413 contacts of 1,568 index cases, of whom 82 (1.5%) were diagnosed with TB disease. We conducted univariate and multivariate clustered logistic regression analyses of risk factors for any TB diagnosis among child household contacts of TB cases. Children younger than 5 years and children with positive HIV status were more likely to have TB than children aged 5-14 years and children with negative HIV status, respectively (adjusted odds ratio [aOR]: 2.2, P < 0.001; aOR: 5.0, P < 0.001). Children with one or more TB symptoms were more likely to be diagnosed with TB based on clinical criteria, but less likely to have bacteriologically confirmed TB, highlighting subjectivity in determination of child TB.

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Implementation of an active, clinic-based child tuberculosis contact management strategy in western Kenya

Cited by 8 publications

References 5 publications

Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial

Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial

Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya

Distinct Risk Factors for Clinical and Bacteriologically Confirmed Tuberculosis among Child Household Contacts in a High-Burden Setting

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