Browsing by Author "Peña, Carlos"

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    Estrategia de pesquisa sistemática y seguimiento prolongado revela alto número de nuevas infecciones tuberculosas en contactos adultos en la Región Metropolitana, Chile
    (2020) Balcells Marty, María Elvira; Carvajal, Camila; Fernández, Paula; Ruiz-Tagle, Cinthya; Pizarro, Alejandra; García, Patricia; Peña, Carlos; Cuevas, Gerardo; Naves, Rodrigo
    Background: Contact investigation is cardinal in the control of tuberculosis (TB) since it helps to stop its transmission. In Chile, the National TB Program strategy does not include latent TB infection testing, regular chemoprophylaxis or follow-up in adults. Active TB was found in only 1.2% of contacts at country-level during 2018. Aim: To evaluate the performance of a systematic screening ofadult household contacts with targeted chemoprophylaxis and prolonged active follow-up. Material and Methods: Prospective cohort of household contacts in Santiago. Two face-to-face visits (at 0 and 12 weeks) that included QuantiFERON TB-Gold plus tests (QFT), chest radiography (CXR) at 0 and 24 weeks and, periodic text messaging or phone call follow-up for up to 48 weeks were implemented. Contacts with positive QFT were referred for TB chemoprophylaxis. Results: A total of 200 contacts were enrolled, 69% were migrants. At baseline evaluation, 45% had a positive QFT result and 1.6% had co-prevalent active TB. At follow-up, 13% contacts further converted to QFT (+), and 5.1% more were diagnosed with active TB (mean follow-up time 32 weeks). Of these 10 further active TB cases, 6 (60%) had a negative QFT and all (100%) had normal CXR at baseline; while three cases occurred in QFT converters. Conclusions: In this cohort of household contacts, 6.7 % were diagnosed with active TB (more than 2/3 at follow-up) and 13% had a late QFT (+) conversion. Active and prolonged contacts’ follow-up are essential to detect new infections and tackle the TB epidemic in Chile.
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    Reducing household tuberculosis transmission. A pilot cluster-randomized controlled trial
    (2025) Ruiz-Tagle Seguel, Cinthya Grace; Seguel Araus, Romina Javiera; Villarroel del Pino, Luis A.; Bernales, Margarita; Vargas García, Salvador; Pizarro Ibañez, Alejandra Valentina; Peña, Carlos; Neira, Víctor; García Cañete, Patricia; Allel Henríquez, Kasim Ignacio; Nathavitharana, Ruvandhi R.; Balcells Marty, María Elvira
    Background: The duration of infectiousness following pulmonary tuberculosis treatment initiation remains uncertain. We aimed to assess whether a bundled intervention designed to decrease respiratory exposure was feasible and would reduce new tuberculosis infections in household contacts (HHCs). Methods: We conducted a pilot cluster-randomized controlled trial with a hybrid type 1 effectiveness-implementation design in Santiago, Chile. Random allocation was performed, and two healthcare districts were assigned to the intervention (n=180 HHCs) and one to standard of care (n=149 HHCs). Eligible participants were newly diagnosed pulmonary tuberculosis patients and their HHCs. The intervention included education, mask use, household ventilation, and nightly separation of tuberculosis patients, for two weeks. Intervention adherence was evaluated weekly. Effectiveness was assessed at the individual level with QuantiFERON®-TB Gold Plus (QFT) test conversions in HHCs at 12-week follow-up. Results: Between October 2021 and December 2023, 384 HHCs and 157 tuberculosis patients were enrolled. Overall, 56.3% of contacts were women, with mean age of 34.6 years and a baseline QFT positivity of 32.3%. A total of 216 contacts had negative QFT result at baseline, with 179 (82.9%) completing follow-up. QFT conversions occurred in 11 (12.8%) and 10 (10.8%) HHCs from the intervention and control arms, respectively (incidence risk ratio 1.10, 95% CI 0.71-1.71, p=0.849). Good adherence to the respiratory bundle was reported by 53% of participants on day 7 and 54% on day 14.