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

Abstract 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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Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation.

10.21203/rs.3.rs-63508/v2 ◽

2020 ◽

Author(s):

Mercedes Yanes Lane ◽

Anete Trajman ◽

Mayara Lisboa Bastos ◽

Olivia Oxlade ◽

Chantal Valiquette ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Household Contacts ◽

Follow Up Study ◽

Infection Treatment ◽

Care Workers ◽

Cascade Of Care ◽

Latent Tb ◽

Latent Tb Infection

Abstract 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 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 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. RESULTS: In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, -15) but the number starting latent TB infection treatment was sustained (difference 2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB 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 sustained 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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Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation.

10.21203/rs.3.rs-63508/v3 ◽

2021 ◽

Author(s):

Mercedes Yanes Lane ◽

Anete Trajman ◽

Mayara Lisboa Bastos ◽

Olivia Oxlade ◽

Chantal Valiquette ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Household Contacts ◽

Follow Up Study ◽

Infection Treatment ◽

Care Workers ◽

Cascade Of Care ◽

Latent Tb ◽

Latent Tb Infection

Abstract 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 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 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. RESULTS: In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, -15) but the number starting latent TB infection treatment was sustained (difference 2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB 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 sustained 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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Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation

BMC Public Health ◽

10.1186/s12889-021-10195-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mercedes Yanes-Lane ◽

Anete Trajman ◽

Mayara Lisboa Bastos ◽

Olivia Oxlade ◽

Chantal Valiquette ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Household Contacts ◽

Follow Up Study ◽

Infection Treatment ◽

Care Workers ◽

Cascade Of Care ◽

Latent Tb ◽

Latent Tb Infection

Abstract 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 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 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. Results In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, − 15) but the number starting latent TB infection treatment was sustained (difference -2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB 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 sustained 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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Experiences with latent TB cascade of care strengthening for household contacts in Calgary, Canada

Public Health Action ◽

10.5588/pha.20.0082 ◽

2021 ◽

Vol 11 (3) ◽

pp. 126-131

Author(s):

N. Bedingfield ◽

L. Barss ◽

O. Oxlade ◽

D. Menzies ◽

D. Fisher

Keyword(s):

Treatment Recommendation ◽

Foreign Born ◽

Ltbi Treatment ◽

Household Contacts ◽

Care Workers ◽

Assessment And Treatment ◽

Cascade Of Care ◽

Latent Tb ◽

Latent Tb Infection

SETTING: Identification, assessment, and treatment of latent TB infection (LTBI), collectively known as the LTBI cascade of care, is critical for TB prevention.OBJECTIVE: The objective of this research, conducted within the ACT4 trial, was to assess and strengthen the LTBI cascade of care for household contacts at Calgary TB Services, a clinic serving a predominately foreign-born population in Western Canada.DESIGN: Baseline assessment consisted of a retrospective LTBI cascade analysis of 32 contact investigations, and questionnaires administered to patients and health care workers. Four solutions were implemented in response to identified gaps. Solution impact was measured for 6 months using descriptive statistics.RESULTS: Pre-implementation, 56% of household contacts initiated treatment. Most contacts were lost to care because the tuberculin skin test (TST) was not initiated, or physicians did not recommend treatment. Evening clinics, a patient education pamphlet, a nursing workshop, and treatment recommendation guidelines were implemented. Post-implementation, losses due to LTBI treatment non-recommendation were reduced; however, the overall proportion of household contacts initiating treatment did not increase.CONCLUSION: Close engagement between researchers and TB programmes can reduce losses in the LTBI cascade. To see sustained improvement in overall outcomes, long-term engagement and data collection for ongoing problem-solving are required.

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Agreement, Sensitivity, and Specificity of Tuberculin Skin Test and T-Spot TB Examination, in Detecting Latent TB Infection among Health Care Workers

Strengthening Hospital Competitiveness to Improve Patient Satisfaction and Better Health Outcomes ◽

10.26911/the6thicph.01.63 ◽

2019 ◽

Author(s):

Yusup Subagio Sutanto ◽

◽

Paulus Arka Triyoga ◽

Harsini Harsini ◽

Reviono Reviono ◽

...

Keyword(s):

Health Care ◽

Tuberculin Skin Test ◽

Skin Test ◽

Sensitivity And Specificity ◽

Health Care Workers ◽

Care Workers ◽

Latent Tb ◽

Latent Tb Infection

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Upregulation of PD-1 expression on circulating CD8+ but not CD4+ T cells is associated with tuberculosis infection in health care workers

BMC Immunology ◽

10.1186/s12865-021-00433-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Cui-lin Shi ◽

Jian-ping Zhang ◽

Ping Xu ◽

Jin Li ◽

Jie Shen ◽

...

Keyword(s):

Health Care ◽

T Cells ◽

T Cell ◽

Health Care Workers ◽

Cd4 T Cells ◽

Receptor Expression ◽

Effector Memory ◽

Care Workers ◽

Latent Tb ◽

Latent Tb Infection

Abstract Background Health care workers (HCWs) are at risk for occupationally acquired Mycobacterium tuberculosis infection and tuberculosis (TB) disease due to repeated exposure to workplace tubercle bacilli. To determine whether continual mycobacterial stimulation correlates with increased expression of inhibitory T cell receptors, here we compared PD-1 receptor expression on surfaces of circulating T cells between naïve (uninfected) HCWs and HCWs with latent TB infection (LTBI). Result Data collected from 133 medical workers who met study selection criteria were included in the final analysis. QuantiFERON-TB Gold In-Tube (QFT-GIT) testing yielded positive results for 32 HCWs, for an overall LTBI rate of 24.1%. Multivariate analysis identified HCW length of service > 15 years as an independent risk factor for a positive QFT-GIT result. In addition, comparisons of blood T cell subgroup profiles between QFT- and QFT+ groups indicated QFT+ subjects possessed greater proportions of mature (TM), transitional memory (TTM) and effector memory (TEM) CD4+ T cell subgroups and lower proportions of naïve T cells (TN). Moreover, the QFT+ group percentage of CD8+ T cells with detectable surface PD-1 was significantly higher than the corresponding percentage for the QFT- group. Meanwhile, no statistical intergroup difference was observed in percentages of CD4+ T cells with detectible surface PD-1. Conclusions Our data demonstrated that upregulated PD-1 expression on circulating CD8+, but not CD4+ T cells, was associated with latent TB infection of HCWs. As compared to other hospitals, occupational TB infection risk in our hospital was substantially mitigated by implementation of multitiered infection control measures.

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