A public health approach to increase treatment of latent TB among household contacts in Brazil

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 administered 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 provided 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 standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.

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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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Preventing Healthcare Workers From Acquiring Influenza

Infection Control and Hospital Epidemiology ◽

10.1086/595690 ◽

2009 ◽

Vol 30 (3) ◽

pp. 292-295 ◽

Cited By ~ 21

Author(s):

Tak Ching Ng ◽

Nelson Lee ◽

Shu-Cheong David Hui ◽

Raymond Lai ◽

Margaret Ip

Keyword(s):

Risk Factors ◽

High Risk ◽

Odds Ratio ◽

Healthcare Workers ◽

Influenza Season ◽

Standard Precautions ◽

Household Contacts ◽

Suboptimal Adherence ◽

Independent Risk Factors ◽

To Receive

Our survey of 133 on-duty medical ward nurses showed that, during peak influenza season, 30 (23%) developed an influenza-like illness, despite wearing a mask at work. Suboptimal adherence to standard precautions, such as the use of a face shield (odds ratio, 3.56) during high-risk procedures, and failure to receive influenza vaccination (odds ratio, 4.82) were independent risk factors, adjusted for household contacts.

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Tuberculosis amidst COVID-19 pandemic in India: unspoken challenges and the way forward

Tropical Medicine and Health ◽

10.1186/s41182-021-00377-1 ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Mainak Bardhan ◽

Mohammad Mehedi Hasan ◽

Ishita Ray ◽

Anusua Sarkar ◽

Priyanka Chahal ◽

...

Keyword(s):

High Risk ◽

Healthcare Workers ◽

Regional Distribution ◽

Vulnerable Population ◽

Adverse Outcomes ◽

Drug Supply ◽

Active Screening ◽

The Future ◽

Latent Tb ◽

Latent Tb Infection

AbstractIndia is home to the most significant number of tuberculosis (TB) cases around the globe. The COVID-19 crisis has deeply perturbed most of the essential TB services in India. Regulating TB is difficult in a densely populated country like India due to latent TB infection in millions of Indians, which can reactivate at any point in the future. Due to the ongoing pandemic, healthcare workers have been diverted to activities implemented for effective COVID-19 management, leaving a meager workforce to help deal with TB management. Integrating TB and COVID-19 to augment India’s health outreach is the need of the hour to diminish the effect of the COVID-19 crisis on TB. Increasing overall testing capacity, active screening, implementation of strategies for easy identification of TB hotspots, and ensuring uninterrupted drug supply for treatment through heedful planning of local and regional distribution and transportation will especially help cater to the vulnerable population who are at a high risk of suffering from adverse outcomes of TB. Lessons learnt in the battle against COVID-19 can most definitely help in providing insights to fulfill the goal of eliminating TB from India.

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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/v1 ◽

2020 ◽

Author(s):

Mercedes Yanes-Lane ◽

Anete Trajman ◽

Mayara Lisboa Bastos ◽

Olivia Oxlade ◽

Chantal Valiquette ◽

...

Keyword(s):

Health Care Workers ◽

Intervention Trial ◽

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 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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Tuberculosis care among refugees arriving in Europe: a ERS/WHO Europe Region survey of current practices

European Respiratory Journal ◽

10.1183/13993003.00840-2016 ◽

2016 ◽

Vol 48 (3) ◽

pp. 808-817 ◽

Cited By ~ 55

Author(s):

Masoud Dara ◽

Ivan Solovic ◽

Giovanni Sotgiu ◽

Lia D'Ambrosio ◽

Rosella Centis ◽

...

Keyword(s):

Management Practices ◽

Interferon Γ ◽

Control Measures ◽

European Countries ◽

Ltbi Treatment ◽

Ltbi Screening ◽

Infection Control Measures ◽

Latent Tb ◽

Latent Tb Infection ◽

Tuberculosis Care

No evidence exists on tuberculosis (TB) and latent TB infection (LTBI) management policies among refugees in European countries.A questionnaire investigating screening and management practices among refugees was sent to 38 national TB programme representatives of low and intermediate TB incidence European countries/territories of the WHO European Region.Out of 36 responding countries, 31 (86.1%) reported screening for active TB, 19 for LTBI, and eight (22.2%) reporting outcomes of LTBI treatment. Screening for TB is based on algorithms including different combinations of symptom-based questionnaires, bacteriology and chest radiography and LTBI screening on different combinations of tuberculin skin test and interferon-γ release assays. In 22 (61.1%) countries, TB and LTBI screening are performed in refugee centres. In 22 (61.1%) countries, TB services are organised in collaboration with the private sector. 27 (75%) countries answered that screening for TB is performed as per national and international guidelines, while 19 (52.7%) gave the same answer with regards to LTBI screening. Infection control measures are inadequate in several of the countries surveyed.There is need for improved coordination of TB screening in Europe to implement the End TB Strategy and achieve TB elimination.

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Ongoing tuberculosis transmission among second-generation Ethiopian immigrants

Epidemiology and Infection ◽

10.1017/s0950268820001715 ◽

2020 ◽

Vol 148 ◽

Author(s):

H. Bishara ◽

M. Green ◽

D. Chemtob ◽

A. Saffouri ◽

L. Zelikman ◽

...

Keyword(s):

Second Generation ◽

High Risk Group ◽

Ltbi Treatment ◽

Treatment Practice ◽

Ethiopian Immigrants ◽

Tuberculosis Transmission ◽

Contact Investigation ◽

Latent Tb ◽

Latent Tb Infection ◽

Close Contacts

Abstract Despite considerable efforts to control tuberculosis (TB) among Ethiopian immigrants in Israel, an outbreak of TB among second-generation Ethiopian immigrants that involved native Israelis occurred between January 2011 and December 2019. The aim of this article is to report on this outbreak and discuss the patient and health system barriers that led to its propagation. Overall, 13 culture-positive TB patients were diagnosed in this outbreak. An additional 36 cases with identical mycobacterium tuberculosis genotypes were identified through cross-checking with the National TB Laboratory Registry. Among the 32 close contacts of the index case, 18 (56.3%) reported for screening and treatment of latent TB infection (LTBI) was recommended for 11 (61.1%) of them. However, none completed treatment and eight eventually developed TB. Of the 385 close contacts identified in this outbreak, 286 (74.3%) underwent contact investigation, 154 (53.8%) were recommended LTBI treatment, but only 26 (16.9%) completed the treatment. Routine contact investigation and treatment practice measures failed to contain the cascade of infection and disease, leading to the spread of the infecting strain of TB. This report highlights the challenges to identify the high-risk group and address barriers to care among such a vulnerable population.

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Acquisition of Meningococcal Serogroup W-135 Carriage in Turkish Hajj Pilgrims Who Had Received the Quadrivalent Meningococcal Polysaccharide Vaccine

Clinical and Vaccine Immunology ◽

10.1128/cvi.00314-12 ◽

2012 ◽

Vol 20 (1) ◽

pp. 66-68 ◽

Cited By ~ 37

Author(s):

M. Ceyhan ◽

M. Celik ◽

E. T. Demir ◽

V. Gurbuz ◽

A. E. Aycan ◽

...

Keyword(s):

Public Health ◽

Meningococcal Disease ◽

Health Problem ◽

Family Members ◽

Public Health Problem ◽

Polysaccharide Vaccine ◽

Invasive Meningococcal Disease ◽

Household Contacts ◽

To Receive ◽

Close Contacts

ABSTRACTInvasive meningococcal disease is a recognized public health problem worldwide, with a dynamic and changeable epidemiology. In Turkey, the second most common pathogenic meningococcal serogroup (after serogroup B) is W-135, including an epidemic in 2005, which has been strongly associated with Hajj pilgrims and their close contacts. In two studies conducted in 2010, we assessed meningococcal carriage in intending Turkish pilgrims to the Hajj when they attended to receive a plain polysaccharide vaccine against serogroups A, C, W-135, and Y and, upon their return, to determine the acquisition of meningococcal carriage by the pilgrims themselves and subsequently their household contacts. Nasopharyngeal swabs were obtained from pilgrims before the Hajj and upon their return. Swabs were then obtained from 39 household contacts of pilgrims who were shown to have acquired carriage during the Hajj. Of the 472 pilgrims before the Hajj, 63 (13%) were positive for meningococcal carriage, of which 52 cases (83%) were serogroup W-135. In the 296 pilgrims tested after the Hajj, 81 (27%) were positive for meningococcal carriage, including 74 (91%) with W-135. In 11 family members of pilgrims who acquired W-135 carriage at the Hajj, 10 (91%) had acquired carriage of serogroup W-135. This study illustrates the acquisition of meningococcal carriage, predominantly of serogroup W-135 by pilgrims attending the Hajj, and the transmission of this carriage to their family members on their return, explaining the source of W-135 meningococcal disease in Turkey.

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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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