HIV-infected children, previously paralysed postexposure IPT programmes have been enhanced through the introduction of IPT registers and the increased availability of single-drug dispersible paediatric isoniazid (INH) formulations.South Africa, an upper middle-income country, has a medium human development index, but it fi gures among the 22 countries with the highest burden of TB disease. 12 Although the South African National TB Programme (SANTP) has been recommending postexposure IPT for many years for child contacts aged <5 years, IPT uptake ranges from <5% 10 to 21% in routine health care settings, 9 to 73% in clinical research settings, 5,13 while adherence is approximately 24%. 5,13 Among South African children hospitalised for TB, opportunities for IPT are missed in up to 70% of young children. 14,15 A growing body of literature shows that obstacles to the effective delivery of postexposure IPT are many and inter-related. 9,10 Many of the major barriers identifi ed in a recent review of problems in IPT implementation have been resolved in South Africa using a standardised screening protocol for children. However, the issues of maintaining adherence to extended prophylactic treatment programmes and the negotiation of care giver acceptability needs further consideration. 16 A recent survey of parents currently administering IPT in Cape Town found very positive responses to IPT once these barriers had been overcome. 17 We completed a qualitative assessment to understand factors infl uencing parents' decisions to allow IPT to be administered to their children and completion of the 6-month course of treatment.
RESEARCH SETTINGThe study was set in three impoverished urban communities in Cape Town, Western Cape Province, South Africa. Study Communities 1 and 2 are geographically adjacent and their ethnicity is classifi ed as 'coloured' or 'mixed race'. The third community is of predominantly black ethnicity. In 2011, the overall TB notification rate in the Western Cape Province was 994 per 100 000 population and >1000/100 000 in the communities studied; TB reported in children aged 0-13 years accounted for 17% of the disease and an age-specifi c TB notifi cation rate of 620/100 000 in 2008 (unpublished data, Western Cape Department of Health, 2009). The estimated annual risk of M. tuberculosis infection was 4.1% in the fi rst two communities, where 30% of children aged 6-9 years were tuberculin skin test (TST) positive. 18 In the third community, 26% of In-depth interviews were conducted with two parents of children adherent to IPT and two staff members from three primary health care clinics in high TB prevalence communities. Themes explored were knowledge and attitudes towards IPT, problems in accessing and adhering to treatment, and community responses. Results: Parents administering treatment valued it positively, realised their children's risk of TB, and were positive about the clinic. Nurses acknowledged that resistance to treatment remained, with some parents not wanting to acknowledge risk nor willing to...
