TB contact tracing for young children: an Australian cascade of care review

Abstract

OBJECTIVE: To evaluate care cascades for programmatic active case finding and latent TB infection (LTBI) management in young child TB contacts (aged <5 years) in Victoria, Australia.DESIGN: This was a retrospective review of public health surveillance data to identify contacts of all pulmonary TB cases notified from 2016 to 2019.RESULTS: Contact tracing identified 574 young child contacts of 251 pulmonary TB cases. Active TB was found in 28 (4.9%) contacts, none of whom had previously received bacille Calmette-Guérin vaccination, and 529 were tested for TB infection using the tuberculin skin test (TST). The overall TST positivity was 15.3% (95% CI 0.1–0.2). Among the 574 children, 150 (26.1%) were close contacts of sputum smear-positive cases and 25 (16.7%) of these were not referred to TB clinics. Of the 125 referred, 81 were considered to have LTBI, 79 agreed to commence TB preventive treatment (TPT) and 71 (89.9%) completed TPT. Following completion of TPT, no child was subsequently diagnosed with active TB.CONCLUSION: There was a high yield from active case finding and uptake of TPT. Notable losses in the cascade of care occurred around referral to tertiary clinics, but high treatment completion rates and good outcomes were found in those prescribed treatment.

Knowledge, attitude, and practices regarding childhood tuberculosis detection and management among healthcare providers in Cambodia: a cross-sectional study

“…However, a significantly higher proportion of providers from ODs with high childhood TB case detection strongly agreed and agreed to bring family members and close contacts of smear-positive pulmonary TB for TB screening. This finding suggests that the attitude toward contact investigation of providers from ODs with low childhood TB case detection needs to be strengthened since contact investigation has been shown as a key intervention contributing to childhood TB case detection [ 25 – 31 ]. A significantly higher proportion of respondents from ODs with high childhood TB case detection strongly agreed that staff in their health facilities received adequate childhood TB training than those from ODs with low childhood TB case detection.…”

“…These better practices could be due to more supports available in facilities under the Global Fund’s coverage and may contribute to higher childhood TB case detection [ 35 , 36 ]. The NTP should consider strengthening good practices on contact investigation in health facilities and communities in ODs not supported by the Global Fund to improve TB case detection among children [ 25 – 31 ]. Other good practices toward childhood TB case detection, such as referrals of children who might have TB for TB diagnostic work-up, were also higher in ODs with the Global Fund’s supports, although the differences were not statistically significant.…”

Pilot study to identify missed opportunities for prevention of childhood tuberculosis

“…A second US study identified shortcomings in 16% of children < 14 years [ 19 ]. An Australian study described notable losses in TB contact tracing for children < 5 years around referral to TB clinics [ 20 ]. A study from Germany showed that in children ( n = 276) up to the age of 5 years identified through contact tracing, only 32% were screened according to current guidelines and only 20% received prophylactic and/or preventive treatment [ 21 ].…”

Tuberculosis notifications in regional Victoria, Australia: Implications for public health care in a low incidence setting

“…Funded by the Victorian Government Department of Health, VTP is a centralised program located in metropolitan Victoria and works in partnership with hospitals and clinics in managing tuberculosis. All tuberculosis patients in Victoria are supervised by VTP nurse consultants [ 13 , 14 ].…”