The following is a summary of “Multicenter Analysis of Attrition from the Pediatric Tuberculosis Infection Care Cascade in Boston,” published in the FEBRUARY 2023 issue of Pediatrics by Campbell, et al.
For a retrospective cohort study, researchers sought to characterize losses from pediatric tuberculosis (TB) infection care cascade and identify ways to improve TB infection care delivery.
The study included a retrospective cohort of children (age <18 years) who were screened for TB within two health systems in the Boston area between January 2017 and May 2019. In addition, patients who received a tuberculin skin test (TST) and/or an interferon-gamma release assay (IGRA) were included.
A total of 13,353 tests among 11,622 patients were included, with a completion rate of 93.9%. Of the 199 patients with positive tests for whom TB infection evaluation was clinically appropriate, 59.3% completed treatment or were recommended not to start treatment. The odds of testing completion were increased for patients aged 12-17 years (vs <5 years; aOR 1.59; 95% CI, 1.32-1.92), those with a non-English/non-Spanish language preference (vs English; aOR, 1.34; 95% CI, 1.02-1.76), and those who received an IGRA (vs TST; aOR, 30.82; 95% CI, 21.92-43.34). The odds of testing completion decreased as the census tract social vulnerability index quartile increased (i.e., social vulnerability worsened; most vulnerable quartile vs least vulnerable quartile, aOR, 0.77; 95% CI, 0.60-0.99). The 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).
The study found that completion of testing was high, but completion of evaluation and treatment was moderate among children with a high proportion of negative TB infection tests. The study suggested that transitions toward IGRA testing will improve testing completion, and interventions addressing social determinants of health were important to improve treatment completion for pediatric TB infection care delivery.
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