Denoeud-Ndam Lise, Tchounga Boris Kevin, Masaba Rose, Herrera Nicole, Machekano Rhoderick, Siamba Stephen, Ouma Millicent, Petnga Saint Just, Simo Leonie, Tchendjou Patrice, Bissek Anne Cécile, Okomo Gordon Odhiambo, Casenghi Martina, Tiam Appolinaire
Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon.
BMJ Glob Health. 2024 Dec 18;9(12):e016429. doi: 10.1136/bmjgh-2024-016429.
Paediatric tuberculosis (TB) underdiagnosis is a critical concern. The INPUT stepped-wedge cluster-randomised trial assessed the impact of integrating child TB services into child healthcare on TB case detection among children under age 5 years.
We compared the standard of care, providing TB care in specific TB clinics (control phase), with the Catalysing Paediatric TB Innovations (CaP-TB) intervention, integrating TB services across all child health services (intervention phase). 12 clusters in Cameroon and Kenya transitioned from the standard of care to the intervention at randomly assigned times. Children with presumptive TB were enrolled after obtaining their parents' consent and were followed throughout TB diagnostic procedures and treatment. Study outcomes included the rate of children with presumptive TB receiving TB investigations and that of children diagnosed with TB (the primary outcome was case detection), per thousand children under 5 years attending facilities. Generalised linear mixed Poisson models estimated the intervention's effect as adjusted rate ratios (aRR) and associated 95% CIs. Ad hoc country-stratified analyses were conducted.
During control and intervention phases, respectively, 121 909 and 109 614 children under 5 years attended paediatric entry points, 133 (1.1 per thousand) and 610 (5.6 per thousand) children with presumptive TB received TB investigations, and 79 and 74 were diagnosed with TB, corresponding to a case detection rate of 0.64 and 0.68 per thousand, respectively. CaP-TB significantly increased TB investigations in both countries overall (aRR=3.9, 95% CI 2.4 to 5.4), and in each. Overall, TB case detection was not statistically different between intervention and control (aRR 1.32, 95% CI 0.66 to 2.61, p=0.43). Country-stratified analysis revealed a 10-fold increase (aRR 9.75, 95% CI 1.04 to 91.84, p=0.046) in case detection with CaP-TB in Cameroon and no significant effect in Kenya (aRR 0.94, 95% CI 0.44 to 2.01, p=0.88).
CaP-TB increased TB investigations in both study countries and markedly enhanced TB case detection in one, underlining integrated TB services' potential to address paediatric TB underdiagnosis.
儿童结核病诊断不足是一个关键问题。INPUT阶梯式楔形整群随机试验评估了将儿童结核病服务纳入儿童医疗保健对5岁以下儿童结核病病例发现的影响。
我们将在特定结核病诊所提供结核病护理的标准治疗（对照阶段）与促进儿童结核病创新（CaP-TB）干预措施进行了比较，后者将结核病服务整合到所有儿童健康服务中（干预阶段）。喀麦隆和肯尼亚的12个整群在随机分配的时间从标准治疗过渡到干预措施。疑似结核病儿童在获得父母同意后入组，并在整个结核病诊断程序和治疗过程中接受随访。研究结果包括每千名到医疗机构就诊的5岁以下儿童中，疑似结核病儿童接受结核病检查的比例以及被诊断为结核病儿童的比例（主要结果是病例发现率）。广义线性混合泊松模型将干预效果估计为调整率比（aRR）和相关的95%置信区间（CI）。进行了特设的国家分层分析。
在对照阶段和干预阶段，分别有121909名和109614名5岁以下儿童进入儿科就诊点，133名（每千名中有1.1名）和610名（每千名中有5.6名）疑似结核病儿童接受了结核病检查，79名和74名被诊断为结核病，相应的病例发现率分别为每千名0.64和0.68。总体而言，CaP-TB在两个国家均显著增加了结核病检查（aRR=3.9，95%CI为2.4至5.4），且在每个国家都是如此。总体而言，干预组和对照组之间的结核病病例发现率在统计学上没有差异（aRR 1.32，95%CI为0.66至2.61，p=0.4
