Latent tuberculosis in childhood and adolescence: assessment of barriers to diagnosis and treatment in a resource-limited area of Brazil

It is estimated that 70 million children and adolescents have latent tuberculosis infection (LTBI) worldwide, thus representing an important reservoir of the disease. Diagnosis and prophylaxis of LTBI in this population remain a challenge because of social factors and barriers in contact investigation. The objective of this study was to describe barriers in the follow-up of children and adolescents who are household contacts of adults with pulmonary tuberculosis (PTB). This was a prospective cohort study of children and adolescents, household contacts of PTB, followed for 2 years after contact detection, in the region of Itaboraí, Rio de Janeiro, Brazil. Out of 90 subjects included in the study, aged 0-15 years, 44 were lost to follow-up (48.9%), poverty being the main cause of being lost to follow-up. In the multivariate analysis, losses to follow-up were associated with male gender (P = .01) and with the caregiver's low level of education (P = .001). There was a lower chance of being lost to follow-up when the infection source was a sibling (P = .004). The absence of a guardian to accompany the child to medical consultations was linked to the loss of follow-up (P = .07). The main barriers to the diagnosis and treatment of LTBI in children and adolescents in our study population were socioeconomic and educational factors. Preventive treatment is still a challenge in tuberculosis endemic areas.