Pediatric Tuberculosis Infection Care Facilitators and Barriers: A Qualitative Study

Area of Science:

• Pediatric infectious diseases
• Public health

Background:

• An estimated 700,000 US children and adolescents have latent tuberculosis infection (LTBI).
• Preventing pediatric TB disease requires identifying facilitators and barriers to LTBI care engagement.
• Understanding family and clinician perspectives is vital for improving pediatric LTBI care.

Purpose of the Study:

• To explore facilitators and barriers to pediatric latent tuberculosis infection diagnosis and care from the perspectives of families and clinicians.
• To inform the development of interventions aimed at improving engagement in pediatric TB infection care.

Main Methods:

• Individual interviews and small group discussions were conducted with clinicians (n=24) and caregivers (n=19).
• Applied thematic analysis was used to identify key themes related to care engagement.
• A cascade-grounded pediatric TB infection care engagement framework was utilized.

Main Results:

• Themes influencing care engagement included risk identification and communication, care accessibility, cost-related barriers, and medication adherence support.
• Patient and family factors such as TB knowledge, trust, behavioral skills, parenting, and resources also impacted care.
• Both clinic/health system and patient/family-level factors were identified as critical.

Conclusions:

• Risk identification, education, trust, family resources, TB stigma, and care ecosystem accessibility significantly influenced engagement in the pediatric TB infection care cascade.
• An integrated framework for pediatric TB infection care engagement was developed.
• This framework can guide multilevel interventions to enhance retention in pediatric TB infection care.