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Determinants of losses in the tuberculosis infection cascade of care among children and adolescent contacts of pulmonary tuberculosis cases: A Brazilian multi-centre longitudinal study

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dc.contributor.author Sobral, L.
dc.contributor.author Arriaga, Maria B.
dc.contributor.author Souza, A.B.
dc.contributor.author Araújo-Pereira, M.
dc.contributor.author Barreto-Duarte, B.
dc.contributor.author Sales, C.
dc.contributor.author Rocha, M.S.
dc.contributor.author Benjamin, A.
dc.contributor.author Moreira, A.S.R.
dc.contributor.author de Oliveira, J.G.
dc.contributor.author Carvalho, A.C.
dc.contributor.author Spener-Gomes, R.
dc.contributor.author Figueiredo, M.C.
dc.contributor.author Cavalcante, S.
dc.contributor.author Durovni, B.
dc.contributor.author Lapa-e-Silva, J.R.
dc.contributor.author Kritski, A.L.
dc.contributor.author Rolla, V.C.
dc.contributor.author Sterling, T.R.
dc.contributor.author Cordeiro-Santos, M.
dc.contributor.author Andrade, B.B.
dc.contributor.author RePORT Brazil consortium
dc.date.accessioned 2022-12-14T14:25:35Z
dc.date.available 2022-12-14T14:25:35Z
dc.date.issued 2022
dc.identifier.uri https://hdl.handle.net/20.500.12866/12896
dc.description.abstract Background: Approximately 10% of the global tuberculosis (TB) burden is in children. Identification, diagnosis, and early treatment of Mycobacterium tuberculosis infection (TBI) is critical to prevent progression to TB in children. The risk of TB, including severe disease, is highest in children <5 years old. We evaluated the cascade of TBI care among child and adolescent TB contacts to identify factors associated with losses in the cascade. Methods: Close contacts ≤ 18 years old of pulmonary TB patients enrolled between 2015 and 2019 in a multi-centre Brazilian cohort were followed for up to 24 months and classified according to age groups: <5 years, 5–9 years, 10–14 years and 15–18 years. Data on clinical investigation, radiographic examination, IGRA testing at baseline and 6 months, initiation and completion of TB preventive treatment (TPT) were collected. Multivariable regression analyses identified factors associated with TBI and losses in the cascade of care in children and adolescents. Findings: Among 1795 TB contacts initially identified, 530 (29·5%) were ≤18 years old. Losses for all steps in the cascade were especially high in children <5 years old (88%) because at this age all contacts are recommended to initiate TPT. As a proportion of all children, completion of TPT was low (between 10% and 13%) in all age-groups. Furthermore, multivariable regression revealed that younger age of contacts and TB index cases who were female, had pulmonary cavities, and persistent cough were independently associated with losses in the cascade of care among persons ≤18 years old. Interpretation: Losses in the TBI cascade were the highest among children <5 years, which was the group at highest risk for TB among the four age groups. The findings highlight the need to improve screening, initiation, and completion of TPT of young children who are close contacts of people with TB in Brazil. Funding: National Institutes of Allergy and Infectious Diseases. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet Regional Health - Americas
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Children en_US
dc.subject Contact en_US
dc.subject Latent tuberculosis en_US
dc.subject Pediatric en_US
dc.subject TBI cascade en_US
dc.title Determinants of losses in the tuberculosis infection cascade of care among children and adolescent contacts of pulmonary tuberculosis cases: A Brazilian multi-centre longitudinal study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.lana.2022.100358
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.05
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.09
dc.relation.issn 2667-193X


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