Yanes-Lane Mercedes, Trajman Anete, Bastos Mayara Lisboa, Oxlade Olivia, Valiquette Chantal, Rufino Nathalia, Fregonese Federica, Menzies Dick
Research Institute McGill University Health Centre, Montreal, Quebec, Canada.
Internal Medicine Graduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
BMC Public Health. 2021 Jan 21;21(1):177. doi: 10.1186/s12889-021-10195-z.
Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives.
In two health clinics in Rio de Janeiro that received the interventions in the trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions.
In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, - 15) but the number starting latent TB infection treatment was sustained (difference -2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment.
In this follow-up study, we observed a sustained effect of interventions to strengthen the latent TB infection cascade of care on increasing the number of household contacts starting latent TB infection treatment.
由于潜伏性结核感染护理流程中多个环节出现流失情况，需要接受结核病预防性治疗的患者中，完成治疗的比例不到19%。在里约热内卢开展了一项整群随机试验，采用一项公共卫生项目干预措施来改善对家庭接触者潜伏性结核感染的管理。干预措施包括接触者登记、初始培训和在职培训，以及一本结核病手册。在该试验结束一个月后，我们开展了一项随访研究，以衡量所实施干预措施的效果，并从不同角度确定潜伏性结核感染治疗尚存的障碍和促进因素。
在里约热内卢接受试验干预措施的两家卫生诊所，在五个月的时间里收集了家庭接触者潜伏性结核感染护理流程的数据。将每100例结核病确诊患者中开始治疗的家庭接触者数量与干预试验之前和期间获得的护理流程数据进行比较。针对医护人员、家庭接触者和结核病确诊患者，就结核病知识以及对研究干预措施的看法，发放了半结构化开放式问卷。
在这项随访研究中，每100例结核病确诊患者中确定了184名家庭接触者。与干预期相比，每100例结核病确诊患者中的家庭接触者减少了65名（(95% CI -115, -15)），但开始潜伏性结核感染治疗的人数保持稳定（差异为-2，95% CI -8,5）。共采访了31例结核病确诊患者、22名家庭接触者和19名医护人员。在结核病确诊患者中，61%表示其所有家庭接触者都接受了潜伏性结核感染检测。所有医护人员均表示对家庭接触者进行检测非常重要，95%的医护人员提到，掌握潜伏性结核感染治疗益处的正确知识是促使他们推荐这种治疗方法的主要因素。
在这项随访研究中，我们观察到加强潜伏性结核感染护理流程的干预措施在增加开始潜伏性结核感染治疗的家庭接触者数量方面具有持续效果。
