Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
J Pediatric Infect Dis Soc. 2022 Oct 31;11(Supplement_3):S94-S100. doi: 10.1093/jpids/piac070.
Tuberculosis (TB) preventive therapy (TPT) is increasingly recognized as the key to eliminating tuberculosis globally and is particularly critical for children with TB infection or who are in close contact with individuals with infectious TB. But many barriers currently impede successful scale-up to provide TPT to those at high risk of TB disease. The cascade of care in TB infection (and the related contact management cascade) is a conceptual framework to evaluate and improve the care of persons who are potential candidates for TPT. This review summarizes recent literature on barriers and solutions in the TB infection care cascade, focusing on children in both high- and low-burden settings, and drawing from studies on children and adults. Identifying and closing gaps in the care cascade will require the implementation of tools that are new (e.g. computer-assisted radiography) and old (e.g. efficient contact tracing), and will be aided by innovative implementation study designs, quality improvement methods, and shared clinical practice with primary care providers.
结核病（TB）预防治疗（TPT）越来越被认为是在全球消除结核病的关键，对于感染结核病或与传染性结核病患者密切接触的儿童尤为重要。但目前许多障碍阻碍了向高危结核病患者提供 TPT 的成功扩大规模。TB 感染护理级联（以及相关的接触管理级联）是一个概念框架，用于评估和改善可能接受 TPT 的人的护理。本综述总结了 TB 感染护理级联中障碍和解决方案的最新文献，重点关注高负担和低负担环境中的儿童，并借鉴了儿童和成人的研究。确定和缩小护理级联中的差距将需要实施新的工具（例如计算机辅助放射摄影）和旧的工具（例如高效的接触者追踪），并通过创新的实施研究设计、质量改进方法以及与初级保健提供者共享临床实践来辅助。
