Adherence and Toxicity during the Treatment of Latent Tuberculous Infection in a Referral Center in Spain.

The screening and treatment of latent tuberculosis infection (LTBI) in countries with a low incidence of TB is a key strategy for the elimination of tuberculosis (TB). However, treatment can result in adverse events (AEs) and have poor adherence. This study aimed to describe treatment outcomes and AEs for LTBI patients at two departments in Vall d'Hebron University Hospital in Barcelona, Spain. A retrospective study was conducted on all persons treated for LTBI between January 2018 and December 2020. Variables collected included demographics, the reason for LTBI screening and treatment initiation, AEs related to treatment, and treatment outcome. Out of 261 persons who initiated LTBI treatment, 145 (55.6%) were men, with a median age of 42.1 years. The indications for LTBI screening were household contact of a TB case in 96 (36.8%) persons, immunosuppressive treatment in 84 (32.2%), and recently arrived migrants from a country with high TB incidence in 81 (31.0%). Sixty-three (24.1%) persons presented at least one AE during treatment, and seven (2.7%) required definitive discontinuation of treatment. In the multivariate analysis, AE development was more frequent in those who started LTBI treatment due to immunosuppression. Overall, 226 (86.6%) completed treatment successfully. We concluded that LTBI screening and treatment groups had different risks for adverse events and treatment outcomes. Persons receiving immunosuppressive treatment were at higher risk of developing AEs, and recently arrived immigrants from countries with a high incidence of TB had greater LTFU. A person-centered adherence and AE management plan is recommended.

Health and Vaccination Status of Unaccompanied Minors After Arrival in a European Border Country: A Cross-sectional Study (2017-2020).

BACKGROUND: Unaccompanied and separated children (UASC) are a high-risk group for infectious diseases and information on their vaccination status is scarce. Different approaches are used to screen newly arrived minors in Europe. The aim of this study was to describe the health status and serological protection against different vaccine-preventable diseases among UASC to inform public health decision-making. METHODS: Retrospective study of all UASC seen at an international health reference center in Barcelona (Spain) between January 2017 and February 2020. Screening results were analyzed using binary logistic regression with adjustment for symptoms, geographic origin, and time since arrival. RESULTS: We studied 289 UASC (88.9% males; median age, 17 years). At least one infection was diagnosed in 136 minors (47.1%). There was a high prevalence of intestinal parasites (22.8%), latent tuberculosis infection (22.5%), and hepatitis B (5.2%), even in asymptomatic individuals, and especially among UASC from sub-Saharan Africa (odds ratio, 2.5; 95% confidence interval, 1.5-4.0, P < 0.001). We did not observe a significant association between clinical symptoms and the presence of infection or differences in the prevalence of different infections according to number of months since arrival. Protection against hepatitis B virus (36%), measles (80%), and varicella (83%) was suboptimal. CONCLUSIONS: Our results highlight the importance of screening and vaccination programs for UASC arriving in Europe, especially border countries. Protocols should be adjusted according to geographic origin. Absence of symptoms does not necessarily rule out infection, highlighting the importance of screening in asymptomatic minors. These programs are a public health priority and should not be neglected during the current COVID-19 pandemic.

Proyecto de educación sanitaria en la autoadministración de interferón pegilado en la coinfección VIH/VHC usando el método PRECEDE como herramienta de diagnóstico de la conducta / Health education project in self-administration of pegylated interferon in HIV/hepatitis C virus coinfection using the PRECEDE method as a tool for behavioral diagnosis

En España, la prevalencia de coinfección por el virus de la inmunodeficiencia humana-virus de la hepatitis C (VIH-VHC) es una de las más elevadas, ya que tanto la infección por el VHC como por VIH comparten vías de transmisión. La curación del VHC en pacientes coinfectados depende del genotipo de VHC, y el tratamiento que se recomienda se basa en interferón pegilado de administración subcutánea y ribavirina en comprimidos. El tratamiento se realiza durante un tiempo determinado (de 6 meses a 1 año), pero tiene efectos secundarios limitantes en la vida diaria que hacen necesario un proceso de educación sanitaria. La metodología PRECEDE es un modelo que permite realizar diagnósticos comportamentales individuales y de grupo que tiene por objetivo conseguir el cambio de comportamientos, actitudes y conocimientos del paciente. Un buen diagnóstico conductual, previo a la intervención, garantiza la adecuación y la eficacia de las intervenciones para apoyar a las personas coinfectadas de VIH-VHC en la adherencia al tratamiento

The prevalence of HIV/hepatitis C virus (HCV) coinfection in Spain is one of the highest since both these infections share routes of transmission. Resolution of HCV in coinfected patients depends on HCV genotype and treatment. The recommended treatment consisted of subcutaneous administration of pegylated interferon and oral ribavirin. Treatment is administered for a specific period (from 6 months to 1 year), but has secondary effects that limit the patient's daily life and require a health education process. The PRECEDE method can be used to make individual and group behavioral diagnoses that aim to effect changes in patients' behavior, attitudes and knowledge. An accurate preintervention behavioral diagnosis guarantees the suitability and effectiveness of interventions to support HIV/HCV coinfected individuals in treatment adherence