Driving to Reduce Socioeconomic Barriers to Latent Tuberculosis Infection Care: A Mobile Pediatric Treatment Program

Area of Science:

• Public Health
• Pediatric Infectious Diseases
• Epidemiology

Background:

• Tuberculosis (TB) poses significant global health challenges, with latent tuberculosis infection (LTBI) in children requiring effective prevention strategies.
• Underresourced pediatric populations, particularly those who are foreign-born, are at higher risk for TB and often face barriers to accessing healthcare.
• Mobile clinic programs offer a unique approach to reach underserved communities and address healthcare gaps.

Purpose of the Study:

• To describe the implementation and outcomes of a latent tuberculosis infection (LTBI) treatment program within a pediatric mobile clinic setting.
• To evaluate the effectiveness of a community-based approach in preventing tuberculosis among high-risk children.
• To assess the feasibility of utilizing mobile clinics for LTBI screening and treatment in underresourced populations.

Main Methods:

• A collaborative effort between the Texas Children's Mobile Clinic Program (TC-MCP) and TB experts established an LTBI treatment protocol.
• Patients underwent tuberculin skin tests (TSTs), followed by interferon-γ release assays (IGRAs) for positive TSTs, and chest radiographs (CXRs) for IGRA-positive cases.
• Children diagnosed with LTBI (positive IGRA, normal CXR) received 12 once-weekly doses of isoniazid/rifapentine (3HP) through outpatient mobile clinic visits.

Main Results:

• Out of 785 patients screened, 38 (4.8%) had positive TSTs. A total of 19 patients were diagnosed with LTBI.
• 18 out of 19 LTBI patients completed the 3HP therapy, with 83% attending at least two in-person mobile clinic visits.
• The program demonstrated successful LTBI treatment completion within a community-based mobile clinic setting for a high-risk pediatric population.

Conclusions:

• Mobile clinics can effectively extend the reach of healthcare services to underresourced children, successfully identifying and treating latent tuberculosis infection.
• Community partnerships and a structured LTBI treatment program are vital for preventing the progression of tuberculosis in vulnerable pediatric populations.
• This model highlights the potential of mobile health initiatives to bridge healthcare disparities and improve public health outcomes for infectious diseases.