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Objective To map which tuberculosis care models are best suited for children and adolescents. Methods We conducted a scoping review to assess the impact of decentralized, integrated and family-centred care on child and adolescent tuberculosis-related outcomes, describe approaches for these care models and identify key knowledge gaps. We searched seven literature databases on 5 February 2021 (updated 16 February 2022), searched the references of 18 published reviews and requested data from ongoing studies. We included studies from countries with a high tuberculosis burden that used a care model of interest and reported tuberculosis diagnostic, treatment or prevention outcomes for an age group < 20 years old. Findings We identified 28 studies with a comparator group for the impact assessment and added 19 non-comparative studies to a qualitative analysis of care delivery approaches. Approaches included strengthening capacity in primary-level facilities, providing services in communities, screening for tuberculosis in other health services, co-locating tuberculosis and human immunodeficiency virus treatment, offering a choice of treatment location and providing social or economic support. Strengthening both decentralized diagnostic services and community linkages led to one-to-sevenfold increases in case detection across nine studies and improved prevention outcomes. We identified only five comparative studies on integrated or family-centred care, but 11 non-comparative studies reported successful treatment outcomes for at least 71% of children and adolescents. Conclusion Strengthening decentralized services in facilities and communities can improve tuberculosis outcomes for children and adolescents. Further research is needed to identify optimal integrated and family-centred care approaches. Objectif Caracteriser les modeles de prise en charge de la tuberculose les mieux adaptes aux enfants et adolescents. Methodes Nous avons mene une analyse exploratoire afin d'evaluer l'impact d'une prise en charge decentralisee, integree et articulee autour du noyau familial sur les resultats observes chez les enfants et adolescents traites pour une tuberculose, mais aussi de decrire les approches employees pour ces modeles de soins et d'identifier les principales lacunes dans les connaissances a ce sujet. Nous avons effectue des recherches dans sept bases de donnees dediees a la litterature le 5 fevrier 2021 (mise a jour le 16 fevrier 2022), examine les references de 18 revues publiees et demande des informations issues d'etudes en cours. Nous avons inclus des etudes provenant de pays fortement touches par la tuberculose, qui utilisaient un modele de prise en charge digne d'interet et faisaient mention de resultats de diagnostic, de traitement ou de prevention pour une categorie d'age < 20 ans. Resultats Nous avons identifie 28 etudes avec un groupe de comparaison pour mesurer l'impact, et nous avons ajoute 19 etudes non comparatives a une analyse qualitative des approches de prestation de soins. Parmi ces approches figuraient le renforcement des capacites dans les etablissements de niveau primaire, la fourniture de services au sein des communautes, le depistage de la tuberculose dans d'autres services de sante, le regroupement des traitements contre la tuberculose et le virus de l'immunodeficience humaine, la possibilite pour le patient de choisir son lieu de traitement et enfin, la mise a disposition d'une aide sociale ou economique. Developper a la fois les services de diagnostic decentralises et les reseaux communautaires a permis de multiplier par sept le depistage des cas dans neuf etudes, et d'optimiser les resultats de prevention. Nous n'avons trouve que cinq etudes comparatives consacrees aux soins integres ou articules autour du noyau familial. En revanche, 11 etudes non comparatives ont indique que le traitement avait ete couronne de succes chez au moins 71% des enfants et adolescents. Conclusion Renforcer les services decentralises dans les etablissements et communautes peut contribuer a ameliorer l'etat des enfants et adolescents souffrant de tuberculose. D'autres recherches sont necessaires pour degager les meilleures approches integrees et articulees autour du noyau familial. Objetivo Establecer que modelos de atencion a la tuberculosis son los mas adecuados para los ninos y adolescentes. Metodos Se realizo una revision exploratoria para evaluar los impactos de la atencion descentralizada, integrada y orientada a la familia en los desenlaces relacionados con la tuberculosis en ninos y adolescentes, describir los enfoques de estos modelos de atencion e identificar las principales deficiencias de conocimiento. Se realizaron busquedas en siete bases de datos bibliograficas el 5 de febrero de 2021 (actualizadas el 16 de febrero de 2022), se buscaron las referencias de 18 revisiones publicadas y se solicitaron datos de estudios en curso. Se incluyeron estudios de paises con una alta carga de tuberculosis que emplearan un modelo de atencion de interes e informaran sobre los resultados de diagnostico, tratamiento o prevencion de la tuberculosis en un grupo de edad Resultados Se identificaron 28 estudios con un grupo comparativo para la evaluacion del impacto y se anadieron 19 estudios no comparativos a un analisis cualitativo de los enfoques de prestacion de atencion. Los enfoques incluyeron el fortalecimiento de la capacidad en los centros de nivel primario, la prestacion de servicios en las comunidades, la deteccion de la tuberculosis en otros servicios sanitarios, la ubicacion conjunta del tratamiento de la tuberculosis y del virus de la inmunodeficiencia humana, la posibilidad de que el paciente elija el lugar de tratamiento y la prestacion de apoyo social o economico. El refuerzo de los servicios de diagnostico descentralizados y de los vinculos con la comunidad permitio multiplicar de una a siete veces la deteccion de casos en nueve estudios y mejorar los resultados de la prevencion. Solo se identificaron cinco estudios comparativos sobre la atencion integrada u orientada a la familia, pero 11 estudios no comparativos informaron de resultados de tratamiento exitosos en al menos el 71% de los ninos y adolescentes. Conclusion El refuerzo de los servicios descentralizados en los centros y las comunidades puede mejorar los desenlaces de la tuberculosis en ninos y adolescentes. Es preciso seguir investigando para determinar los enfoques optimos de atencion integrada y orientada a la familia., Introduction Of the roughly 10 million people who develop active tuberculosis annually, around one in every six is a child or adolescent aged 0-19 years old. (1,2) In 2020, less [...]

: Introduction: Isoniazid preventive therapy (IPT) can reduce the risk of tuberculosis (TB) in children living with HIV (CLHIV), but data on the outcomes of the IPT cascade in CLHIV are limited. Methods: We evaluated the IPT cascade among CLHIV aged Results: Overall, 856 CLHIV were newly enrolled in HIV care, of whom 98% ([95% CI 97–99]; n = 841) underwent screening for TB symptoms and IPT eligibility. Of these, 13 (2%; 95% CI 1–3) were ineligible due to active TB and 828 (98%; 95% CI 97–99) were eligible. Five hundred and fifty‐nine (68%; 95% CI 64–71) of eligible CLHIV initiated IPT; median time to IPT initiation was 3.6 months (interquartile range [IQR] 0.5–10.2). Overall, 434 (78%; 95% CI 74–81) IPT initiators completed. Attending high‐volume HIV clinics (aRR = 2.82; 95% CI 1.20–6.62) was independently associated with IPT non‐initiation. IPT non‐initiation had a trend of being higher among those enrolled in the period 2017–2019 versus 2015–2016 (aRR = 1.91; 0.98–3.73) and those who were HIV virally non‐suppressed (aRR = 1.90; 95% CI 0.98–3.71). Being enrolled in 2017–2019 versus 2015–2016 (aRR = 1.40; 1.01–1.96) was independently associated with IPT non‐completion. By 24 months after IPT screening, TB incidence was four‐fold higher among eligible CLHIV who never initiated (8.1 per 1000 person years [PY]) compared to CLHIV who completed IPT (2.1 per 1000 PY; rate ratio [RR] = 3.85; 95% CI 1.08–17.15), with a similar trend among CLHIV who initiated but did not complete IPT (8.2/1000 PY; RR = 4.39; 95% CI 0.82–23.56). Conclusions: Despite high screening for eligibility, timely IPT initiation and completion were suboptimal among eligible CLHIV in this programmatic cohort. Targeted programmatic interventions are needed to address these drop‐offs from the IPT cascade by ensuring timely IPT initiation after ruling out active TB and enhancing completion of the 6‐month course to reduce TB in CLHIV., INTRODUCTION Tuberculosis (TB) is a leading cause of death among people living with HIV [1, 2] and a significant cause of morbidity and mortality in children living with HIV (CLHIV) [...]

We explored the utility of brief Mycobacterium tuberculosis whole-genome sequencing (WGS) "snapshots" at a sentinel site within Lima, Peru, for evaluating local transmission dynamics over time. Within a 17-km2 area, 15 of 70 (21%) isolates with WGS collected during 2011–2012 and 22 of 81 (27%) collected during 2020–2021 were clustered (P =.414), and additional isolates clustered with those from outside the area. Isolates from the later period were disproportionately related to large historic clusters in Lima from the earlier period. WGS snapshots at a sentinel site may not be useful for monitoring transmission, but monitoring the persistence of large transmission clusters might be. [ABSTRACT FROM AUTHOR]

Background: Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion. Methods: We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display. Findings: During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs. Conclusions: Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients. [ABSTRACT FROM AUTHOR]