Impact of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: A nonrandomized controlled trial.

AIM: To evaluate the association of a new nursing intervention on the adherence to antituberculosis treatment in a paediatric cohort (<18 years). BACKGROUND: Tuberculosis remains a public health problem worldwide. The risk of developing tuberculosis after primary infection and its severity are higher in children. Proper adherence to antituberculosis treatment is critical for disease control. DESIGN: Nonrandomized controlled trial; Phase 1, retrospective (2011-2013), compared with Phase 2, prospective with intervention (2015-2016), in a referral centre for paediatric tuberculosis in Spain (NCT03230409). METHODS: A total of 359 patients who received antituberculosis drugs after close contact with a smear-positive patient (primary chemoprophylaxis) or were treated for latent tuberculosis infection or tuberculosis disease were included, 261 in Phase 1 and 98 in Phase 2. In Phase 2, a new nurse-led intervention was implemented in all patients and included two educational steps (written information in the child's native language and follow-up telephone calls) and two monitoring steps (Eidus-Hamilton test and follow-up questionnaire) that were exclusively carried out by nurses. RESULTS: Adherence to antituberculosis treatment increased from 74.7% in Phase 1% to 87.8% in Phase 2 (p = 0.014; Chi-square test), after the implementation of the nurse-led intervention. In Phase 2, nonadherence was only associated with being born abroad (28.6% vs. 7.8%; p = 0.019; Chi-square test) and with foreign origin families (27.3% vs. 0%; p < 0.0001; Chi-square test). CONCLUSION: The nurse-led intervention was associated to an increase in adherence to antituberculosis treatment. Immigrant-related variables remained major risk factors for sub-optimal adherence in a low-endemic setting.

Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study.

BACKGROUND: Adult patients receiving anti-TNFα drugs are at increased risk of tuberculosis (TB), but studies in pediatric populations are limited, and the best strategy for latent tuberculosis infection (LTBI) screening in this population remains controversial. We describe the prevalence of LTBI prior to anti-TNFα therapy and the long-term follow-up after biological treatment initiation in a cohort of children and adolescents. METHODS: Cohort observational study in children and adolescents receiving anti-TNFα agents in a tertiary-care pediatric hospital. LTBI was ruled out prior to the implementation of anti-TNFα drugs by tuberculin skin test (TST), and, from March 2012 on, QuantiFERON Gold-In Tube test (QTF-G). During anti-TNFα treatment, patients were evaluated every 6 months for TB with history and physical examination. TST/QTF-G were not repeated unless signs or symptoms consistent with TB arose or there was proven TB contact. RESULTS: The final cohort consisted of 221 patients (56.1% female; 261 treatments), of whom 51.7%/30.0%/17.3% were treated with etanercept/adalimumab/infliximab, respectively, for a variety of rheumatic diseases (75.6%), inflammatory bowel disease (20.8%), and inflammatory eye diseases (3.6%). The median (IQR) age at diagnosis of the primary condition was 6.8 years (2.7-11.0) and the duration of the disease before implementing the anti-TNFα agent was 1.8 years (0.6-4.2). LTBI was diagnosed in 3 adolescent girls (prevalence rate: 1.4%; 95% CI: 0.4-4.2) affected with juvenile idiopathic arthritis: TST tested positive in only 1, while QTF-G was positive in all cases (including 2 patients already on etanercept). They all received antiTB chemoprophylaxis and were later (re)treated with etanercept for 24-29 months, without incidences. No incident cases of TB disease were observed during the follow-up period under anti-TNFα treatment of 641 patients-year, with a median (IQR) time per patient of 2.3 years (1.4-4.3). CONCLUSIONS: In our study, the prevalence of LTBI (1.4%) was similar to that reported in population screening studies in Spain; no incident cases of TB disease were observed. In low-burden TB settings, initial screening for TB in children prior to anti-TNFα treatment should include both TST and an IGRA test, but systematic repetition of LTBI immunodiagnostic tests seems unnecessary in the absence of symptoms or known TB contact.

[THE IMPORTANCE OF PROPER ADHERENCE TO ANTI-TUBERCULOSIS TREATMENT]. / La importancia de una adherencia correcta at tratamiento antitubercutoso.

INTRODUCTION: Tuberculosis (TB) remains a major cause of morbidity and mortality in many countries. This involves a serious public health problem. Adherence to TB treatment is a cornerstone for the control of this disease. DEVELOPMENT: Globally, there are major differences between countries as to the prevalence, incidence and mortality tuberculosis. Spain has a incidence rate higher than that of other countries in their socio-economic background. Treatment is prolonged, with significant side effects. Adherence to treatment is essential to be effective, prevent drug resistance and disease control. Children are more vulnerable to developing the disease than the rest of the population. Several direct and indirect methods measure the adherence to treatment, but none is ideal. Some socio-demographic risk factors that influence on adherence are described (immigration...). In addition, there are another more specific child factors to have been add. CONCLUSIONS: The literature reviewed highlights the importance of proper monitoring of patients to increase adherence to TB treatment. The role of the nurse and their interventions are very important.

Influence of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: research protocol.

AIM: To evaluate the efficacy of nursing interventions on adherence to antituberculosis medication in a paediatric cohort (aged 0-18 years) and to identify the risk factors for non-compliance. BACKGROUND: After primary infection, children have a higher risk of developing tuberculosis and the severity of the disease is worse in children. Adherence to treatment is essential to control both latent infection and tuberculosis disease. DESIGN: Phase 1: retrospective descriptive analysis (n = 270) in children and young people receiving antituberculosis treatment. Phase 2: quasi-experimental, longitudinal, prospective study (n = 100). The results of the two phases will be compared. METHODS: Phase 1: in children followed up during the period 2011-2013 (non-intervention group), the level of adherence and its associated epidemiological, sociocultural and clinical risk factors will be analysed. Phase 2: educational (written information in the child's mother tongue and follow-up telephone calls) and monitoring (Eidus-Hamilton test and follow-up questionnaire) nursing interventions will be implemented. The results of the two phases will be compared. The definitive Nurse-led Follow-up Programme will then be designed. This project was funded in October 2013. DISCUSSION: The risk factors for poor adherence to antituberculosis therapy need to be identified to optimize treatment success in latent tuberculosis infection and disease in children and young people. Simultaneous application of several educational and monitoring methods in nurse-led follow-up shall improve adherence in children and adolescents in our setting. These results may also be applicable in other settings, where tuberculosis is more prevalent and directly observed treatment strategies are not available.

La importancia de una adherencia correcta al tratamiento antituberculoso / The importance of proper adherence to anti-tuberculosis treatment

Introducción. La tuberculosis (TB) sigue siendo una de las principales causas de morbimortalidad en muchos países y esto comporta un problema grave de salud pública. La adherencia al tratamiento antituberculoso es un eje fundamental para el control de esta enfermedad. Desarrollo. A nivel mundial existen grandes diferencias en función del territorio en cuanto a las tasas de prevalencia e incidencia de la enfermedad y su mortalidad. España presenta una tasa de incidencia superior a la de otros países de su entorno socioeconómico. El tratamiento es prolongado y con efectos secundarios importantes. La adherencia al tratamiento es fundamental para que este sea eficaz, para evitar las resistencias a los fármacos y controlar la enfermedad. Los niños son más vulnerables a desarrollar la enfermedad que el resto de la población. Existen distintos tipos de métodos, directos e indirectos, para medir esta adherencia al tratamiento, aunque ninguno es ideal. Están descritos una serie de factores de riesgo de tipo sociodemográfico que influyen en la adherencia, como la inmigración. A los factores que dificultan el seguimiento del tratamiento en el adulto se tienen que sumar otros más específicos a nivel infantil. Conclusiones. La literatura revisada destaca la importancia de un adecuado seguimiento de los pacientes para aumentar la adherencia al tratamiento antituberculoso. El rol de la enfermera y sus intervenciones son muy importantes (AU)

Introduction. Tuberculosis (TB) remains a major cause of morbidity and mortality in many countries. This involves a serious public health problem. Adherence to TB treatment is a cornerstone for the control of this disease. Development: Globally, there are major differences between countries as to the prevalence, incidence and mortality tuberculosis. Spain has a incidence rate higher than that of other countries in their socio-economic background. Treatment is prolonged, with significant side effects. Adherence to treatment is essential to be effective, prevent drug resistance and disease control. Children are more vulnerable to developing the disease than the rest of the population. Several direct and indirect methods measure the adherence to treatment, but none is ideal. Some socio-demographic risk factors that influence on adherence are described (immigration…). In addition, there are another more specific child factors to have been add. Conclusions: The literature reviewed highlights the importance of proper monitoring of patients to increase adherence to TB treatment. The role of the nurse and their interventions are very important (AU)