Age-specific effectiveness of a tuberculosis screening intervention in children

Abstract

Objective To apply a cascade-of-care framework to evaluate the effectiveness-by age of the child-of an intensified tuberculosis patient-finding intervention. Design From a prospective screening program at four hospitals in Pakistan (2014-2016) we constructed a care cascade comprising six steps: screened, positive screen, evaluated, diagnosed, started treatment, and successful outcome. We evaluated the cascade by each year of age from 0 to 14 and report the age-specific mean proportion and standard deviation. Results On average across all ages, only 12.5% (standard deviation: 2.0%) of children with a positive screen were not evaluated. Among children who had a complete evaluation, the highest percentages of children diagnosed with tuberculosis were observed in children 0-4 (mean: 31.9%; standard deviation: 4.8%), followed by lower percentages in children 5-9 (mean: 22.4%; standard deviation: 2.2%), and 10-14 (mean: 26.0%; standard deviation:5.4%). Nearly all children diagnosed with tuberculosis initiated treatment, and an average of 93.3% (standard deviation: 3.3%) across all ages had successful treatment outcomes. Conclusions This intervention was highly effective across ages 0-14 years. Our study illustrates the utility of applying operational analyses of age-stratified cascades to identify age-specific gaps in pediatric tuberculosis care that can guide future, novel interventions to close these gaps. Dubai Harvard Medical Foundation for Medical Research (MBB and MCB), and the National Institutes of Allergy and Infectious Diseases at the National Institutes of Health (K01-AI151083 to MBB and T32-AI007433 to MMD). TB REACH is generously supported by Global Affairs Canada. This manuscript's contents are solely the responsibility of the authors and do not necessarily represent the official views of these organizations. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.