Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings

Area of Science:

• Pediatric infectious diseases
• Public health
• Pharmacology

Background:

• Pediatric tuberculosis infection (TBI) treatment requires effective regimens.
• Rifamycin-based regimens (RBR) offer potential for improved TBI management.
• Implementation of RBRs in diverse clinical settings needs evaluation.

Purpose of the Study:

• To assess the adoption and effectiveness of RBRs for pediatric TBI treatment.
• To compare RBR implementation across academic, federally qualified health center, and public health settings.
• To identify factors influencing RBR utilization and treatment completion in children.

Main Methods:

• Retrospective observational study of 424 pediatric patients (1 month–17 years) treated for TBI between 2018-2020.
• Inclusion of data from an academic center (AC), a federally qualified health center (FQHC), and public health (DPH) tuberculosis clinics.
• Analysis of RBR prescription rates, time to treatment initiation, and treatment completion.

Main Results:

• RBR use for pediatric TBI nearly doubled from 43% to 82% during the study period (P < .001).
• Academic centers and public health clinics were 4 times more likely to prescribe RBRs than FQHCs.
• Treatment completion rates were higher in academic centers and public health clinics (74%) compared to FQHCs.

Conclusions:

• Pediatric TBI treatment with RBRs shows increasing adoption but significant variation across clinical settings.
• Strategies are necessary to enhance RBR uptake and standardize care, especially in general pediatric settings.
• Improving RBR implementation is crucial for optimizing pediatric tuberculosis treatment outcomes.