The Pediatric infectious disease journal · 2012
Successful treatment of pediatric latent tuberculosis infection in a community health center clinic.
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Young Janine, Edick Tara, Klee Debbie, O'Connor Mary Ellen
Аннотация
OBJECTIVE: This study evaluates completion of treatment for latent tuberculosis infection (LTBI) in Mexican immigrant children aged 1-18 years in a Community Health Center (CHC).
METHODS: Children were screened for LTBI at a CHC. All children with a tuberculin skin test (TST) ≥10 mm had a chest radiograph (CXR). Those with negative CXR had nurse appointments to collect demographic information and to begin 9 months of INH treatment. A minimum 6 months of INH treatment defined completion.
RESULTS: Between November 15, 2006 and March 15, 2009, 157 children had positive TSTs. Three never had a CXR, 2 had misdiagnosed LTBI and 2 had asymptomatic active tuberculosis. Of 150 with LTBI, 111 (74%) completed INH at CHC. Thirteen (9%) transferred care to school-based clinics or TB clinic (TBC) and 4 (3%) never started treatment. Twenty-two (15%) did not complete treatment at CHC. One developed INH hepatitis and 21 were lost to follow-up. Of 13 who transferred to school-based clinics/TBC, 10 completed therapy, with 121 (81%) completing treatment started at CHC. By logistic regression factors associated with not starting/incomplete LTBI treatment were older age, increased number of days between TST and CXR, and 0-1 well care visits versus ≥2 visits before TST placement. A visit co-pay ≥$15.00 was associated with transfer of care to school-based clinics/TBC.
CONCLUSIONS: Pediatric LTBI can be successfully treated by CHC nurses. Completion of treatment was associated with younger age, fewer days between TST reading and CXR, and being an established patient in the CHC.
METHODS: Children were screened for LTBI at a CHC. All children with a tuberculin skin test (TST) ≥10 mm had a chest radiograph (CXR). Those with negative CXR had nurse appointments to collect demographic information and to begin 9 months of INH treatment. A minimum 6 months of INH treatment defined completion.
RESULTS: Between November 15, 2006 and March 15, 2009, 157 children had positive TSTs. Three never had a CXR, 2 had misdiagnosed LTBI and 2 had asymptomatic active tuberculosis. Of 150 with LTBI, 111 (74%) completed INH at CHC. Thirteen (9%) transferred care to school-based clinics or TB clinic (TBC) and 4 (3%) never started treatment. Twenty-two (15%) did not complete treatment at CHC. One developed INH hepatitis and 21 were lost to follow-up. Of 13 who transferred to school-based clinics/TBC, 10 completed therapy, with 121 (81%) completing treatment started at CHC. By logistic regression factors associated with not starting/incomplete LTBI treatment were older age, increased number of days between TST and CXR, and 0-1 well care visits versus ≥2 visits before TST placement. A visit co-pay ≥$15.00 was associated with transfer of care to school-based clinics/TBC.
CONCLUSIONS: Pediatric LTBI can be successfully treated by CHC nurses. Completion of treatment was associated with younger age, fewer days between TST reading and CXR, and being an established patient in the CHC.