Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings
To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county. A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a gene...
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| Veröffentlicht in: | The Journal of pediatrics 2023-08, Vol.259, p.113419-113419, Article 113419 |
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| container_title | The Journal of pediatrics |
| container_volume | 259 |
| creator | Malhotra, Sanchi Dasgupta-Tsinikas, Shom Yumul, Josephine Kaneta, Kelli Lenz, Annika Kizzee, Richard Bihm, Dustin Jung, Christina Neely, Michael Guevara, Ramon E. Higashi, Julie Bender, Jeffrey M. |
| description | To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county.
A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin.
We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P |
| doi_str_mv | 10.1016/j.jpeds.2023.113419 |
| format | Article |
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A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin.
We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9).
The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2023.113419</identifier><identifier>PMID: 37044372</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>infectious diseases ; public health ; tuberculosis elimination</subject><ispartof>The Journal of pediatrics, 2023-08, Vol.259, p.113419-113419, Article 113419</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c309t-dcab124e514b4de2e2c353a1890d65d8f3d9fcf246f60e237228b7642d085a833</cites><orcidid>0000-0002-2485-3927</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpeds.2023.113419$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37044372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Malhotra, Sanchi</creatorcontrib><creatorcontrib>Dasgupta-Tsinikas, Shom</creatorcontrib><creatorcontrib>Yumul, Josephine</creatorcontrib><creatorcontrib>Kaneta, Kelli</creatorcontrib><creatorcontrib>Lenz, Annika</creatorcontrib><creatorcontrib>Kizzee, Richard</creatorcontrib><creatorcontrib>Bihm, Dustin</creatorcontrib><creatorcontrib>Jung, Christina</creatorcontrib><creatorcontrib>Neely, Michael</creatorcontrib><creatorcontrib>Guevara, Ramon E.</creatorcontrib><creatorcontrib>Higashi, Julie</creatorcontrib><creatorcontrib>Bender, Jeffrey M.</creatorcontrib><title>Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county.
A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin.
We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9).
The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.</description><subject>infectious diseases</subject><subject>public health</subject><subject>tuberculosis elimination</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kEtLAzEUhYMotlZ_gSCzdDP15jGvhQvxWRAsWAVXIZPcSEo7U5OZgv_e1LYuXd3FPeeeez5CzimMKdD8aj6er9CEMQPGx5RyQasDMqRQFWlecn5IhgCMpVwU-YCchDAHgEoAHJMBL0AIXrAh-XhX3qnOtU3immTmUXVLbLqktckUTdx4p5NZX6PX_aINLiSTxqLeG-6cteg3hqlv186gT16x61zzGU7JkVWLgGe7OSJvD_ez26f0-eVxcnvznGoOVZcarWrKBGZU1MIgQ6Z5xhUtKzB5ZkrLTWW1ZSK3OSCLT7OyLnLBDJSZij1H5HJ7d-Xbrx5DJ5cuaFwsVINtHyQrAXLGijKLUr6Vat-G4NHKlXdL5b8lBblhKufyl6ncMJVbptF1sQvo6yWaP88eYhRcbwUYa64dehm0w0ZHfj6ikqZ1_wb8ABG_iQM</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Malhotra, Sanchi</creator><creator>Dasgupta-Tsinikas, Shom</creator><creator>Yumul, Josephine</creator><creator>Kaneta, Kelli</creator><creator>Lenz, Annika</creator><creator>Kizzee, Richard</creator><creator>Bihm, Dustin</creator><creator>Jung, Christina</creator><creator>Neely, Michael</creator><creator>Guevara, Ramon E.</creator><creator>Higashi, Julie</creator><creator>Bender, Jeffrey M.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2485-3927</orcidid></search><sort><creationdate>20230801</creationdate><title>Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings</title><author>Malhotra, Sanchi ; Dasgupta-Tsinikas, Shom ; Yumul, Josephine ; Kaneta, Kelli ; Lenz, Annika ; Kizzee, Richard ; Bihm, Dustin ; Jung, Christina ; Neely, Michael ; Guevara, Ramon E. ; Higashi, Julie ; Bender, Jeffrey M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c309t-dcab124e514b4de2e2c353a1890d65d8f3d9fcf246f60e237228b7642d085a833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>infectious diseases</topic><topic>public health</topic><topic>tuberculosis elimination</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Malhotra, Sanchi</creatorcontrib><creatorcontrib>Dasgupta-Tsinikas, Shom</creatorcontrib><creatorcontrib>Yumul, Josephine</creatorcontrib><creatorcontrib>Kaneta, Kelli</creatorcontrib><creatorcontrib>Lenz, Annika</creatorcontrib><creatorcontrib>Kizzee, Richard</creatorcontrib><creatorcontrib>Bihm, Dustin</creatorcontrib><creatorcontrib>Jung, Christina</creatorcontrib><creatorcontrib>Neely, Michael</creatorcontrib><creatorcontrib>Guevara, Ramon E.</creatorcontrib><creatorcontrib>Higashi, Julie</creatorcontrib><creatorcontrib>Bender, Jeffrey M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Malhotra, Sanchi</au><au>Dasgupta-Tsinikas, Shom</au><au>Yumul, Josephine</au><au>Kaneta, Kelli</au><au>Lenz, Annika</au><au>Kizzee, Richard</au><au>Bihm, Dustin</au><au>Jung, Christina</au><au>Neely, Michael</au><au>Guevara, Ramon E.</au><au>Higashi, Julie</au><au>Bender, Jeffrey M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>259</volume><spage>113419</spage><epage>113419</epage><pages>113419-113419</pages><artnum>113419</artnum><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county.
A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin.
We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9).
The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37044372</pmid><doi>10.1016/j.jpeds.2023.113419</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-2485-3927</orcidid></addata></record> |
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| subjects | infectious diseases public health tuberculosis elimination |
| title | Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings |
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