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Published on: August 16, 2021
Adherence to treatment for tuberculosis infection in children using a comprehensive care strategy: a prospective
Iader Rodríguez-Márquez1,2,3, Dione Benjumea-Bedoya1,2,4, Andrea Victoria Restrepo-Gouzy5
1Grupo de Investigación en Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Antioquia, Medellín, Colombia.
Insights
A new comprehensive care strategy (CCS) significantly improved adherence to treatment for childhood tuberculosis infection (TBI) compared to standard care. This safer approach enhances TBI treatment completion rates in pediatric close contacts.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- Tuberculosis control
Background:
- Low adherence to tuberculosis infection treatment in children hinders global TB control efforts.
- Children in close contact with TB patients are a key population for preventive treatment.
- Evaluating novel strategies to improve treatment adherence in this vulnerable group is critical.
Purpose of the Study:
- To compare the effectiveness of a comprehensive care strategy (CCS) versus standard of care (SOC) for tuberculosis infection treatment adherence in children.
- To assess the safety and efficacy of CCS in improving treatment completion rates among pediatric TB close contacts.
Main Methods:
- A prospective cohort study with historical controls in Colombian children under five, close contacts of pulmonary TB patients.
- CCS involved 4-month rifampicin, multidisciplinary care, and logistical support.
- SOC followed 9-month isoniazid according to program regulations.
Main Results:
- Treatment adherence was 76.7% with CCS versus 40.8% with SOC.
- Children receiving CCS had an 87% higher probability of treatment adherence.
- Adverse events were significantly lower in the CCS group (3 vs. 24).
Conclusions:
- The comprehensive care strategy (CCS) significantly and safely increases adherence to tuberculosis infection treatment in children compared to standard of care.
- CCS demonstrates potential for improved tuberculosis control in pediatric populations.
- Further cost-effectiveness analyses are recommended for programmatic implementation of CCS.
Background:
Low adherence to treatment for tuberculosis infection (TBI) in children threatens tuberculosis (TB) control goals. This research focuses on children with close contact to TB and TBI. This study evaluated adherence to treatment of TBI using a comprehensive care strategy (CCS) for close-contact children with pulmonary TB compared with standard of care (SOC).
Methods:
A prospective cohort study with a historical control group was conducted on children under five, who were close contacts of patients with bacteriologically confirmed pulmonary TB in three Colombian cities (study registration number: NCT04331262). The CCS comprised clinical evaluations, rifampicin for four months, multidisciplinary care, and logistical support, while the SOC followed program regulations with isoniazid for nine months. The primary outcome was the proportion of children completing 100% treatment during follow-up, and the secondary outcome was treatment-related adverse events (AEs).
Findings:
213 children in the SOC group and 86 children in the CCS group were analyzed. The treatment adherence in the SOC group was 40·8% (95% CI 34%; 48%), while in the CCS group it was 76·7% (95% CI 66%; 85%). Children exposed to CCS had 87% higher probability of adherence to TBI treatment compared to SOC (RR 1·87; 95% CI 1·52; 2·31). The incidence of AEs was lower in the CCS group (n = 3) than in those receiving SOC (n = 24).
Interpretation:
The CCS increases adherence to treatment for TBI in children safely compared to SOC. Future cost-effectiveness studies will help implement this strategy in programmatic settings.
Funding:
Colombian Ministry of Science, Technology and Innovation.
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