RT Journal Article
SR Electronic
T1 Determinants of losses in the latent tuberculosis infection cascade of care in Brazil
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e005969
DO 10.1136/bmjgh-2021-005969
VO 6
IS 9
A1 Alexandra Brito Souza
A1 María B Arriaga
A1 Gustavo Amorim
A1 Mariana Araújo-Pereira
A1 Betânia M F Nogueira
A1 Artur T L Queiroz
A1 Marina C Figueiredo
A1 Michael S Rocha
A1 Aline Benjamin
A1 Adriana S R Moreira
A1 Jamile G Oliveira
A1 Valeria Rolla
A1 Betina Durovni
A1 José R Lapa e Silva
A1 Afrânio L Kritski
A1 Solange Cavalcante
A1 Timothy Sterling
A1 Bruno B Andrade
A1 Marcelo Cordeiro-Santos
A1 ,
YR 2021
UL http://gh.bmj.com/content/6/9/e005969.abstract
AB Introduction Factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil.Methods Close contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6–24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade.Results Among 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/pardo (brown) race were independently associated with losses in the cascade.Conclusion There were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.Data are available upon reasonable request. Data Availability Statement: Due to ethical restrictions regarding participant's privacy, data are available upon request. Data are available upon request for researchers who meet the criteria for access to confidential data. Additional requests for the data may be sent to the corresponding author Marcelo Cordeiro-Santos (marcelocordeiro.br@gmail.com).