Knowledge about tuberculosis transmission and prevention and perceptions of health service utilization among index cases and contacts in Brazil: Understanding losses in the latent tuberculosis cascade of care

Salame, Flavia Matos; Ferreira, Márcia Danielle; Belo, M; Teixeira, Emerson Luiz; Cordeiro-Santos, Marcelo; Ximenes, Ricardo Arraes de Alencar; Albuquerque, Maria de Fátima Militão de; Hill, Philip C.; Menzies, Dick; Trajman, Anete

doi:10.1371/journal.pone.0184061

Cited by 26 publications

(29 citation statements)

References 19 publications

(25 reference statements)

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“…Previous studies of the cascade of LTBI care in Brazil had also demonstrated the highest losses in the initial steps (identi cation and investigation). (12,13) As mentioned by HCW in the questionnaires, interventions such as training, TB booklet and in-service training helped improve contact identi cation and treatment initiation. Notwithstanding, HCW also mentioned that clinics are understaffed and have a high demand from the public, which may have limited the capacity for contact identi cation once the intervention trial ended.…”

Section: Discussionmentioning

confidence: 99%

Effects of Programmatic Interventions to Improve the Management of Latent Tuberculosis: A Follow Up Study Up to Five Months After Implementation.

Yanes‐Lane

Trajman

Bastos

et al. 2020

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BACKGROUND: Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives.METHODS: In two health clinics in Rio de Janeiro, that received the interventions in the intervention trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 TB index-patients was compared with cascade data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and TB index-patients regarding knowledge and perceptions about TB and study interventions. RESULTS: In this follow-up study, 184 household contacts per 100 TB index-patients were identified which was 65 fewer per 100 TB index-patients, (95% CI -115, -15) but the number of household contacts starting latent TB infection treatment was sustained (difference 2, 95% CI -8,5). A total of 31 TB index-patients, 22 household contacts and 19 health care workers were interviewed. Among TB index-patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment.CONCLUSION: In this follow-up study, we observed a persistent effect of interventions to strengthen the latent TB infection cascade of care, on increasing the number of household contacts starting latent TB infection treatment.

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Section: Discussionmentioning

confidence: 99%

Effects of Programmatic Interventions to Improve the Management of Latent Tuberculosis: A Follow Up Study Up to Five Months After Implementation.

Yanes‐Lane

Trajman

Bastos

et al. 2020

Preprint

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“…In Brazil, major losses occur in the early steps of the cascade of care for LTBI: only 43% of all close contacts are identified, and, of those, only 3% are started on treatment. 7 Perceptions on the part of index patients and contacts do not seem to be at the root of this problem. Index patients fear that contacts will become ill and do tell them that they have tuberculosis.…”

Section: To the Editormentioning

confidence: 99%

“…Contacts also fear TB and declare that they would take treatment to prevent it if prescribed. 7 In the present study, we used a knowledge, attitudes, and practices survey 8 in order to explore the perspectives of primary care physicians and nurses regarding TB transmission and prevention at 12 primary health care clinics in the cities of Recife, Manaus, and Rio de Janeiro, where the incidence of tuberculosis in Brazil is highest. 9 The present study is part of a larger study aimed at implementing solutions to the aforementioned problem (ClinicalTrials.gov identifier: NCT00931736 [http://www.clinicaltrials.gov/]).…”

Section: To the Editormentioning

confidence: 99%

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Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis

et al. 2018

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“…Treatment of latent TB is the public health measure with the greatest impact on TB incidence rates 5 . In Brazil, only a negligible share of individuals targeted for this intervention are properly treated 18 , despite the high efficacy of the treatment regimens currently recommended by the WHO.…”

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Os Objetivos do Desenvolvimento Sustentável e a tuberculose no Brasil: desafios e potencialidades

2018

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Several of the 17 Sustainable Development Goals (SDG) deal with health issues. The third goal, health and wellbeing, aims to "ensure healthy lives and promote wellbeing for all at all ages" and is clearly related to the tenth goal, the reduction of inequalities, and other SDG 1. The SDG agenda, which succeeds the Millennium Development Goals (MDG), proposes to leave no one behind. In terms of health, the most coherent and accessible proposal to achieve these goals is universal health care through a strong primary health care system 2. There are many challenges for meeting the targets within the SDG. An example is tuberculosis (TB). TB still poses a huge global health threat, with some 10 million new cases per year. In 2016, 1.3 million people died of TB, and another 370 deaths occurred in people living with HIV/AIDS 3. Among the global efforts to control the disease, TB was included in target 3.3 of SDG 3. The challenge is to eliminate TB as an endemic through 90% reduction in mortality and 80% in incidence by 2030, in order to eliminate the disease by 2050. The World Health Organization (WHO) launched the End TB Strategy to support these targets, with the additional goal that no patient should need to bear the catastrophic costs and social repercussions of the disease 4. This concern reflects the view that TB maintains the most vulnerable populations in a vicious circle, a view that sustains target 3.8 of the SDG 1 , which deals with achieving universal health coverage, includes protection from financial risk, and complements TB control. To reach these targets, three lines of action are recommended for governments: patient-centered care and prevention integrated with other care, bold policies and strong health systems, and acceleration of research and innovation 4. At the current rate of reduction, these targets will not be reached within the deadlines laid out in international agreements 5. Different tools are needed, since TB has biological, clinical, and socioeconomic determinants, including coinfection with HIV, malnutrition, smoking, poverty, overcrowding, and insufficient access to health care 4. In Brazil, many determinants of TB overlap in poor urban communities, making it increasingly unlikely to meet the targets. In these neighborhoods, TB incidence exceeds 300/100,000 inhabitants, compared to 32.4/100,000 inhabitants in the country as a whole 6. Another extremely vulnerable urban group is Brazil's prison population, with 31 times higher odds of catching TB compared to the general population 7. Such TB hotspots, which must be identified and controlled in order to reduce transmission 8 , reflect the country's health inequalities and pose a special challenge for controlling the disease.

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Knowledge about tuberculosis transmission and prevention and perceptions of health service utilization among index cases and contacts in Brazil: Understanding losses in the latent tuberculosis cascade of care

Cited by 26 publications

References 19 publications

Effects of Programmatic Interventions to Improve the Management of Latent Tuberculosis: A Follow Up Study Up to Five Months After Implementation.

Effects of Programmatic Interventions to Improve the Management of Latent Tuberculosis: A Follow Up Study Up to Five Months After Implementation.

Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis

Os Objetivos do Desenvolvimento Sustentável e a tuberculose no Brasil: desafios e potencialidades

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