A public health approach to increase treatment of latent TB among household contacts in Brazil
A public health approach to increase treatment of latent TB among household contacts in Brazil
Data
2020
Autores
Bastos, M. L.
Oxlade, O.
Benedetti, A.
Fregonese, F.
Valiquette, C.
Lira, S. C. C.
Carvalho-Cordeiro, D.
Cavalcante, J. R.
Faerstein, E.
Trajman, A.
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Tuberculosis and Lung Disease
Resumo
SETTING: Two consecutive trials were conducted to
evaluate the effectiveness of a public health approach to
identify and correct problems in the care cascade for
household contacts (HHCs) of TB patients in three
Brazilian high TB incidence cities.
METHODS: In the first trial, 12 clinics underwent
standardised evaluation using questionnaires admin-
istered to TB patients, HHCs and healthcare workers,
and analysis of the cascade of latent TB care among
HHCs. Six clinics were then randomised to receive
interventions to strengthen management of latent TB
infection (LTBI), including in-service training pro-
vided by nurses, work process organisation and
additional clinic-specific solutions. In the second
trial, a similar but streamlined evaluation was
conducted in two clinics, who then received initial
and subsequent intensive in-service training provided
by a physician.
RESULTS: In the evaluation phase of both trials, many
HHCs were identified, but few started LTBI treatment.
After the intervention, the number of HHCs initiating
treatment per 100 active TB patients increased by 10
(95%CI 11 to 30) in the first trial, and by 44 (95%CI
26 to 61) in the second trial.
DISCUSSION: A public health approach with standard-
ised evaluation, local decisions for improvements,
followed by intensive initial and in-service training
appears promising for improved LTBI management.
Description
Palavras-chave
cascade of care, latent tuberculosis infection, implementation, public health.
Citação
Bastos ML, Oxlade O, Benedetti A, Fregonese F, Valiquette C, Lira SCC, Carvalho-Cordeiro D, Cavalcante JR, Faerstein E, Albuquerque MFM, Cordeiro-Santos M, Hill PC, Menzies D, Trajman A. A public health approach to increase treatment of latent TB among household contacts in Brazil. Int J Tuberc Lung Dis. 2020 Oct 1;24(10):1000-1008. doi: 10.5588/ijtld.19.0728.