Tuberculosis treatment loss to follow-up in children exposed at home: A prospective cohort study

Brooks M.B.; van de Water B.J.; Lecca L.; Huang C.-C.; Trevisi L.; Contreras C.; Galea J.T.; Calderon R.; Yataco R.; Murray M.; Becerra M.C. · Journal of Global Health (2024) · DOI: 10.7189/jogh.14.04194

Resumen

Background Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a significant public health problem. It is important to understand what drives LTFU in children – a population whose treatment and management depend on an adult caregiver – to better provide support services to families affected by TB. Methods We conducted a prospective cohort study of household contacts in Lima, Peru (2009–12). Using multilevel logistic regression analysis, we explored individual-level characteristics of children and their adult household members with TB disease to identify risk factors for LTFU among children initiated on treatment for TB. Results A total of 154 child (0–14 years) household contacts were diagnosed with TB and initiated on treatment. While most (n=133, 86.4%) had a successful outcome, 20 (13.0%) children were LTFU. Six (30.0%) children were LTFU within three months, nine (45.0%) between five to seven months, and three (15.0%) after seven months of treatment being initiated. In univariable analysis, children with index patients above 25 years of age had decreased odds of being LTFU (odds ratio=0.26; 95% confidence interval=0.08-0.84) compared to children with index patients 25 years or younger. Conclusions In this cohort, more than 10% of children sick with TB who were exposed to the disease at home were LTFU. An integrated, family-centred TB prevention and management approach may reduce barriers to a child completing their course of TB treatment.