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Multicenter Study
. 2023 Feb:253:181-188.e5.
doi: 10.1016/j.jpeds.2022.09.038. Epub 2022 Sep 28.

Multicenter Analysis of Attrition from the Pediatric Tuberculosis Infection Care Cascade in Boston

Jeffrey I Campbell  1 , Mary Tabatneck  2 , Mingwei Sun  3 , Wei He  4 , Nicholas Musinguzi  5 , Bethany Hedt-Gauthier  6 , Gabriella S Lamb  7 , Kezia Domond  8 , Don Goldmann  7 , Vishakha Sabharwal  9 , Thomas J Sandora  7 , Jessica E Haberer  8
Affiliations
Multicenter Study

Multicenter Analysis of Attrition from the Pediatric Tuberculosis Infection Care Cascade in Boston

Jeffrey I Campbell et al. J Pediatr. 2023 Feb.

Abstract

Objective: To characterize losses from the pediatric tuberculosis (TB) infection care cascade to identify ways to improve TB infection care delivery.

Study design: We conducted a retrospective cohort study of children (age <18 years) screened for TB within 2 Boston-area health systems between January 2017 and May 2019. Patients who received a tuberculin skin test (TST) and/or an interferon gamma release assay (IGRA) were included.

Results: We included 13 353 tests among 11 622 patients; 93.9% of the tests were completed. Of 199 patients with positive tests for whom TB infection evaluation was clinically appropriate, 59.3% completed treatment or were recommended to not start treatment. Age 12-17 years (vs < 5 years; aOR 1.59; 95% CI, 1.32-1.92), non-English/non-Spanish language preference (vs English; aOR, 1.34; 95% CI, 1.02-1.76), and receipt of an IGRA (vs TST, aOR, 30.82; 95% CI, 21.92-43.34) were associated with increased odds of testing completion. Odds of testing completion decreased as census tract social vulnerability index quartile increased (ie, social vulnerability worsened; most vulnerable quartile vs least vulnerable quartile, aOR, 0.77; 95% CI, 0.60-0.99). Odds of completing treatment after starting treatment were higher in females (vs males; aOR, 2.35; 95% CI, 1.14-4.85) and were lower in patients starting treatment in a primary care clinic (vs TB/infectious diseases clinic; aOR, 0.44; 95% CI, 0.27-0.71).

Conclusions: Among children with a high proportion of negative TB infection tests, completion of testing was high, but completion of evaluation and treatment was moderate. Transitions toward IGRA testing will improve testing completion; interventions addressing social determinants of health are important to improve treatment completion.

Keywords: care cascade; interferon gamma release assay; latent tuberculosis; pediatric; tuberculin.

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Conflict of interest statement

Conflict of interest disclosures: Dr. Haberer is a consultant for Merck. The other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Summary of analyzed tests and patients.
Figure 2.
Figure 2.
Attrition from and completion of the TB infection care cascade. *Includes the 1 patient who was recommended to not start treatment. †Includes 11 patients who moved away during treatment
See this image and copyright information in PMC

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