Introduction Factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil. Methods Close contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6–24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade. Results Among 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/ pardo (brown) race were independently associated with losses in the cascade. Conclusion There were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil. Data are available upon reasonable request.

中文翻译：

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巴西潜伏性结核病感染级联护理损失的决定因素

引言 在巴西高流行地区的多中心前瞻性队列中，研究了与结核病 (TB) 患者接触者的潜伏性结核病感染 (LTBI) 级联护理损失相关的因素。方法 前瞻性研究2015~2019年间1187例培养确诊肺结核患者的密切接触者，随访6~24个月。收集了通过临床调查、放射学检查和干扰素-γ 释放试验 (IGRA) 进行结核病筛查的数据。多变量回归用于确定 LTBI 级联损失的决定因素。结果 在最初确定的 4145 名结核病接触者中，有 1901 名接受了检查（54% 丢失）。在接受检查的人中，933 人是 HIV 感染者，≤ 5 岁和/或 IGRA 结果呈阳性，因此建议开始结核病预防治疗 (TPT)。其中，454 人（23%）开始治疗，247 人（54% 开始治疗；26% 建议治疗）完成了 TPT。多变量回归分析显示，感染艾滋病毒、文盲和黑人/帕多（棕色）种族与级联损失独立相关。结论 在所有 LTBI 级联阶段都有损失，尤其是在初始筛选和检查步骤。在巴西，社会经济地位低下和 HIV 感染者的密切接触者无法完成 LTBI 级联护理的风险更高。可应合理要求提供数据。多变量回归分析显示，感染艾滋病毒、文盲和黑人/帕多（棕色）种族与级联损失独立相关。结论 在所有 LTBI 级联阶段都有损失，尤其是在初始筛选和检查步骤。在巴西，社会经济地位低下和 HIV 感染者的密切接触者无法完成 LTBI 级联护理的风险更高。可应合理要求提供数据。多变量回归分析显示，感染艾滋病毒、文盲和黑人/帕多（棕色）种族与级联损失独立相关。结论 在所有 LTBI 级联阶段都有损失，尤其是在初始筛选和检查步骤。在巴西，社会经济地位低下和 HIV 感染者的密切接触者无法完成 LTBI 级联护理的风险更高。可应合理要求提供数据。在巴西，社会经济地位低下和 HIV 感染者的密切接触者无法完成 LTBI 级联护理的风险更高。可应合理要求提供数据。在巴西，社会经济地位低下和 HIV 感染者的密切接触者无法完成 LTBI 级联护理的风险更高。可应合理要求提供数据。