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Effectiveness of a community-based intervention to prevent childhood TB in Lesotho

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BACKGROUND: Child contact management (CCM) is a recognized strategy to prevent TB; however, implementation is suboptimal. PREVENT was a cluster-randomized trial that evaluated the effectiveness and acceptability of a community-based intervention (CBI) to improve CCM in Lesotho.

METHODS: Ten health facilities (HFs) were randomized to CBI or standard-of-care (SOC). CBI included nurse training/mentorship, health education by village health workers (VHW), adherence support, and multidisciplinary team meetings. Information on TB cases registered from February 2016 to June 2018 and their child contacts was abstracted. Outcomes were TB preventive treatment (TPT) initiation, TPT completion, and CBI acceptability. Generalized linear mixed models were used to test for differences between study arms and qualitative interview thematic analysis for acceptability.

RESULTS: Among 547 registered children (CBI: n = 399; SOC: n = 148) of 426 adult TB patients, 46% were <2 years, 48% female, and 3% HIV-exposed/positive, with no significant differences between study arms. A total of 501 children initiated TPT—98% at CBI and 88% at SOC HFs (P < 0.0001). TPT completion was 82% in CBI vs. 59% in SOC sites (P = 0.048). Caregivers and providers reported that CBI was acceptable.

CONCLUSION: The CBI was acceptable and significantly improved TPT initiation and completion in Lesotho, offering the opportunity to mitigate the threat of TB among children.

Keywords: TB preventive treatment; child TB contact management; community-based intervention; implementation science

Document Type: Research Article

Affiliations: 1: ICAP at Columbia University, Mailman School of Public Health, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA 2: ICAP at Columbia University, Mailman School of Public Health, New York, NY 3: ICAP at Columbia University, Maseru, Lesotho 4: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa 5: Pediatric Infectious Diseases, State University of New York Stony Brook, Stony Brook, NY, USA 6: Lesotho Ministry of Health National Tuberculosis Programme, Maseru, Lesotho 7: HIV Center for Clinical & Behavioral Studies, Gender, Sexuality and Health Area, at the New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA

Publication date: July 1, 2022

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