Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Bahia, Brazil; Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil.
Int J Infect Dis. 2020 Apr;93:277-283. doi: 10.1016/j.ijid.2020.02.015. Epub 2020 Feb 17.
The present study evaluated factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of tuberculosis (TB) patients, in a referral center from a highly endemic region in Brazil.
Contacts of 1672 TB patients were retrospectively studied between 2009 and 2014. Data on TB screening by clinical investigation, radiographic examination and tuberculin skin test (TST) were extracted from medical records. Losses in the cascade of care and TB incidence within 2-year follow-up were calculated.
From a total of 1180 TB contacts initially identified, only 495 were examined (58% loss), and 20 were diagnosed with active TB at this stage. Furthermore, 435 persons returned for TST result interpretation and 351 (∼81%) were TST positive. Among those with positive TST, 249 (73%) were treated with isoniazid for 6 months whereas 51 abandoned therapy early. Three individuals who did not receive LTBI treatment, one with incomplete treatment and another who completed treatment developed active TB. A logistic regression analysis revealed that increases in age were associated with losses in the LTBI cascade independent of other clinical and epidemiological characteristics.
Major losses occur at initial stages and older patients are at higher risk of not completing the LTBI cascade of care.
本研究评估了巴西高度流行地区转诊中心的结核患者接触者中潜伏性结核感染（LTBI）治疗管理链中断的相关因素。
对 2009 年至 2014 年间的 1672 例结核患者的接触者进行回顾性研究。从病历中提取了关于临床检查、影像学检查和结核菌素皮肤试验（TST）的结核筛查数据。计算了治疗管理链中断和 2 年随访期间的结核发病率。
共发现 1180 例结核接触者，其中仅 495 例进行了检查（58%的失访率），这一阶段有 20 例诊断为活动性结核病。此外，435 人返回进行 TST 结果解读，其中 351 人（约 81%）TST 阳性。TST 阳性者中，249 人（73%）接受了 6 个月的异烟肼治疗，而 51 人早期放弃了治疗。有 3 人未接受 LTBI 治疗，其中 1 人治疗不完整，1 人完成治疗后发生活动性结核病。逻辑回归分析显示，年龄的增加与 LTBI 治疗管理链的中断独立相关，与其他临床和流行病学特征无关。
在初始阶段存在大量的失访，老年患者更有可能无法完成 LTBI 治疗管理链。
