Browsing by Author "Du Preez, Karen"

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    Child contact management in high tuberculosis burden countries : a mixed-methods systematic review
    (Public Library of Science, 2017-03-08) Szkwarko, Daria; Hirsch-Moverman, Yael; Du Plessis, Lienki; Du Preez, Karen; Car, Catherine; Mandalakas, Anna M.
    ENGLISH Abstract: Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children.
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    Complementary surveillance strategies and interventions to inform a tuberculosis care cascade for children
    (Stellenbosch : Stellenbosch University, 2021, 2020-12) Du Preez, Karen; Hesseling, Anneke Catharina; Schaaf, Hendrik Simon; Naidoo, Prenavum; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Monitoring and evaluation is an integral component of tuberculosis (TB) control programmes. Children 0-14 years of age contribute substantially to the global TB epidemic, with an estimated 1 million cases and 233,000 deaths in 2017. The limited availability of age-disaggregated TB surveillance data for paediatric and adolescent populations and the lack of specific monitoring and evaluation approaches, hampers TB control efforts in these special populations. Challenges with the sources and the complexity of TB surveillance data in children compound the current limited monitoring and evaluation efforts for paediatric TB. Only 45% of the estimated number of children globally with TB were reported as diagnosed and treated by TB programmes in 2017. More than half of all paediatric TB cases globally were therefore either undiagnosed, or diagnosed but unreported to TB programmes. A TB care cascade framework has been used successfully in HIV and TB control efforts to identify specific gaps and to monitor the impact of targeted programmatic interventions and could also be useful for monitoring and evaluation of paediatric TB. In an effort to address the lack of monitoring and evaluation approaches for paediatric TB, I investigated the role of diagnostic and treatment surveillance strategies to inform two pillars of a paediatric TB care cascade for South Africa. My research quantified the overall paediatric TB reporting gap in South Africa, showing that nearly a third of South African children with TB are undiagnosed, or diagnosed but unreported. Age- and HIV-stratified analyses of a large national routine TB treatment surveillance dataset, spanning a 13-year period (2004-2016), identified young, HIV-infected children (0-4 years) and adolescents (10-19 years) as populations who require additional targeted TB control interventions in South Africa. Diagnostic surveillance conducted at a large tertiary referral hospital and a district-level hospital in Cape Town, South Africa, quantified the substantial burden and spectrum of paediatric TB routinely managed at these levels of care (~400 and ~170 children annually at each hospital, respectively). Surveillance of HIV-infected children and children with TB meningitis (TBM) proved valuable to monitor the impact of TB and HIV prevention strategies and of integrated TB/HIV care. Finally, my research addressed the hospital-reporting gap in a prospective hospital-based study, where an intervention consisting of a simple TB referral service significantly improved recording and reporting as well as linkage to care of children with TB. Including TB data from all hospitals in routine TB surveillance data will substantially reduce the hospital-reporting gap for paediatric TB in South Africa and improve the completeness of routine TB surveillance data. Mandating hospitals to report TB data will also assist with improving the accuracy of reporting on the spectrum of TB disease and HIV data in routine TB surveillance data, increasing the utility of surveillance data for monitoring and evaluation approaches. Together, this research highlights the importance of using multiple sources of data at different levels of health care to strengthen the accuracy and completeness of paediatric TB surveillance. The use of practical monitoring and evaluation approaches, such as a care cascade, can help to improve TB care and services for children and adolescents and will contribute towards achieving the ambitious global targets set for TB control.
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    Complementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in children
    (BioMed Central, 2018-03-23) Du Preez, Karen; Schaaf, H. Simon; Dunbar, Rory; Walters, Elisabetta; Swartz, Alvera; Solomons, Regan; Hesseling, Anneke C.
    Background: Tuberculosis (TB) in young and HIV-infected children is frequently diagnosed at hospital level. In settings where general hospitals do not function as TB reporting units, the burden and severity of childhood TB may not be accurately reflected in routine TB surveillance data. Given the paucibacillary nature of childhood TB, microbiological surveillance alone will miss the majority of hospital-managed children. The study objective was to combine complementary hospital-based surveillance strategies to accurately report the burden, spectrum and outcomes of childhood TB managed at referral hospital-level in a high TB burden setting. Methods: We conducted a prospective cohort study including all children (< 13 years) managed for TB at a large referral hospital in Cape Town, South Africa during 2012. Children were identified through newly implemented clinical surveillance in addition to existing laboratory surveillance. Data were collected from clinical patient records, the National Health Laboratory Service database, and provincial electronic TB registers. Descriptive statistics were used to report overall TB disease burden, spectrum, care pathways and treatment outcomes. Univariate analysis compared characteristics between children identified through the two hospital-based surveillance strategies to characterise the group of children missed by existing laboratory surveillance. Results: During 2012, 395 children (180 [45.6%] < 2 years) were managed for TB. Clinical surveillance identified 237 (60%) children in addition to laboratory surveillance. Ninety (24.3%) children were HIV co-infected; 113 (29.5%) had weight-for-age z-scores <− 3. Extra-pulmonary TB (EPTB) was diagnosed in 188 (47.6%); 77 (19.5%) with disseminated TB. Favourable TB treatment outcomes were reported in 300/344 (87.2%) children with drugsusceptible and 50/51 (98.0%) children with drug-resistant TB. Older children (OR 1.7; 95% CI 1.0–2.8), children with EPTB (OR 2.3; 95% CI 1.5–3.6) and in-hospital deaths (OR 5.4; 95% CI 1.1–26.9) were more frequently detected by laboratory surveillance. TB/HIV co-infected children were less likely to be identified through laboratory surveillance (OR 0.3; 95% CI 0.2–0.5). Conclusions: The burden and spectrum of childhood TB disease managed at referral hospital level in high burden settings is substantial. Hospital-based surveillance in addition to routine TB surveillance is essential to provide a complete picture of the burden, spectrum and impact of childhood TB in settings where hospitals are not TB reporting units.
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    Correction to : The impact of drug resistance on the risk of tuberculosis infection and disease in child household contacts : a cross sectional study
    (BioMed Central, 2017-11-07) Golla, Vera; Snow, Kathryn; Mandalakas, Anna M.; Schaaf, H. Simon; Du Preez, Karen; Hesseling, Anneke C.; Seddon, James A.
    Correction: After publication of the original article [1] the authors noted that the following errors had occurred: The name of the author H. Simon Schaaf had been incorrectly tagged as Simon H. Schaaf. This has been corrected in the author list above. The first p value below Table 1 is listed as p < 0.011, however it should be p < 0.01. An updated version of this table is included with this Correction. The original article has also been corrected.
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    The impact of drug resistance on the risk of tuberculosis infection and disease in child household contacts : a cross sectional study
    (Biomed Central, 2017-08-29) Golla, Vera; Snow, Kathryn; Mandalakas, Anna M.; Schaaf, Simon H.; Du Preez, Karen; Hesseling, Anneke C.; Seddon, James A.
    ENGLISH SUMMARY : Background: The relative fitness of organisms causing drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) is unclear. We compared the risk of TB infection and TB disease in young child household contacts of adults with confirmed DS-TB and MDR-TB. Methods: In this cross-sectional analysis we included data from two community-based contact cohort investigation studies conducted in parallel in Cape Town, South Africa. Children <5 years of age with household exposure to an infectious TB case were included between August 2008 to June 2011. Children completed investigation for TB infection (tuberculin skin test) and TB disease (symptom evaluation, chest radiograph, bacteriology) in both studies using standard approaches. The impact of MDR-TB exposure on each covariate of TB infection and TB disease was assessed using univariable and multivariable logistic regression. Results: Of 538 children included, 312 had DS-TB and 226 had MDR-TB exposure. 107 children with DS-TB exposure had TB infection (34.3%) vs. 101 (44.7%) of children with MDR-TB exposure (adjusted Odds Ratio [aOR]: 2.05; 95% confidence interval [CI]: 1.34–3.12). A total of 15 (6.6%) MDR-TB vs. 27 (8.7%) DS-TB child contacts had TB disease at enrolment (aOR: 0.43; 95% CI: 0.19–0.97). Conclusions: Our results suggest a higher risk of TB infection in child contacts with household MDR-TB vs. DS-TB exposure, but a lower risk of TB disease. Although potentially affected by residual confounding or selection bias, our results are consistent with the hypothesis of impaired virulence in MDR-TB strains in this setting.