51. Closing delivery gaps in the treatment of tuberculosis infection: Lessons from implementation research in Peru
- Author
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Jerome T Galea, Salmaan Keshavjee, Leonid Lecca, Judith Jimenez, Daniela Puma, Tom Nicholson, Ana K. Millones, Mercedes C. Becerra, Roger Calderon, Courtney M. Yuen, Meredith B Brooks, and Gabriela Sophia Pages
- Subjects
Bacterial Diseases ,Male ,National Health Programs ,Epidemiology ,Health Care Providers ,Psychological intervention ,Interferon gamma release assay ,Disease ,Health Services Accessibility ,Medical Conditions ,0302 clinical medicine ,Peru ,Health care ,Medicine and Health Sciences ,Mass Screening ,Medical Personnel ,030212 general & internal medicine ,Child ,Multidisciplinary ,Pharmaceutics ,Middle Aged ,Professions ,Infectious Diseases ,Research Design ,Medicine ,Female ,Research Article ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Clinical Research Design ,Health Personnel ,Science ,030231 tropical medicine ,Research and Analysis Methods ,03 medical and health sciences ,Drug Therapy ,Physicians ,medicine ,Humans ,Mass screening ,Aged ,Preventive healthcare ,Treatment Guidelines ,Health Care Policy ,business.industry ,Tropical Diseases ,medicine.disease ,Health Care ,Health Care Facilities ,Medical Risk Factors ,Family medicine ,People and Places ,Communicable Disease Control ,Population Groupings ,Adverse Events ,Implementation research ,business ,Delivery of Health Care ,Interferon-gamma Release Tests - Abstract
Background Targeted testing and treatment of TB infection to prevent disease is a pillar of TB elimination. Despite recent global commitments to greatly expand access to preventive treatment for TB infection, there remains a lack of research on how best to expand preventive treatment programs in settings with high TB burdens. Methods We conducted implementation research in Lima, Peru, around a multifaceted intervention to deliver TB preventive treatment to close contacts of all ages, health care workers, and people in congregate settings. Key interventions included use of the interferon gamma release assay (IGRA), specialist support for generalist physicians at primary-level health facilities, and treatment support by community health workers. We applied a convergent mixed methods approach to evaluate feasibility and acceptability based on a care cascade framework. Findings During April 2019-January 2020, we enrolled 1,002 household contacts, 148 non-household contacts, 107 residents and staff of congregate settings, and 357 health care workers. Cumulative completion of the TB preventive care cascade was 34% for contacts Conclusions We attempted to close the gap in TB preventive treatment in Peru by expanding preventive services to adult contacts and other risk groups. While suboptimal, care cascade completion for adult contacts was consistent with what has been observed in high-income settings. The major losses in the care cascade occurred in completing evaluations and having doctors prescribe preventive treatment.
- Published
- 2021