Abandonment of Treatment for Latent Tuberculosis Infection and Socioeconomic Factors in Children and Adolescents: Rio De Janeiro, Brazil

Abstract

BackgroundRoutine data on the use of isoniazid preventive therapy (IPT) in children and adolescents are scarce in high tuberculosis (TB) burden countries.ObjectiveTo describe the factors related to abandonment of IPT in children and adolescents with latent tuberculosis infection (LTBI) receiving routine care.MethodsRetrospective (2005–2009) descriptive study of 286 LTBI cases with indication of IPT and serviced at a pediatric hospital in the State of Rio de Janeiro, Brazil. Survival analysis of the risk of abandonment of IPT over six months was performed, including multivariate analysis using the Cox proportional hazards model.ResultsOut of the 245 cases of LTBI included, 62 abandoned IPT (25.3%; 95% CI: 20%-31%). On multivariate analysis, the variables related to the IPT abandonment hazard ratio were the Human Development Index (HDI) (hazard ratio—HR: 0.004; 0.000–0.569) of the place of residence and the contact with adults that were not undergoing anti-TB treatment (HR: 7.30; 1.00–53.3).ConclusionThis study reveals the relevance of the relation of abandonment of IPT to the socioeconomic conditions at the place of residence and poor adherence to the active TB treatment. Educational measures to stimulate preventive treatment of child contacts and curative treatment of index cases should target the full familial setting.

How Can New Technologies Help Reduce Absenteeism in Pediatric Consultation?

“…In Rio de Janeiro, in a study conducted between 2005 and 2009, missing treatment rates of children undergoing treatment for a latent infection were 25.3%. 11 In this study, it was not possible to relate absenteeism and/or stopping treatment to the use of medication or to the length of the follow-up period. Absenteeism may delay a diagnosis and, consequently, the start of treatment, which may interfere with the child's health.…”

Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review

“…A recurring theme throughout the different studies was the burden of travel for caregivers of children that had been advised to complete IPT. While financial cost was an issue for some, the duration of travel from people's homes to the nearest clinic appeared to be the principal issue for many . Seasonal farming demands and other family priorities, particularly for mothers, were often recognised as more important than taking children to the clinic .…”

“…The cost of treatment itself did not appear to present as significant an issue as travel overall; however, this was also mentioned as an obstacle in some areas . Many study participants and authors indicated that enhanced access to IPT through provision at peripheral health sites in rural areas could greatly contribute to improved uptake for children in these regions who may otherwise miss out on treatment . Strategies designed to minimise cost and maximise flexibility would give families the best chance of adhering to IPT.…”

“…In many cultures, preventive treatments are not endorsed and the misconception exists that you do not need medicines if you do not feel sick . Even after receiving health education, many caregivers in the studies reviewed were reluctant to take their children in for screening or IPT initiation because they felt they were healthy and asymptomatic . This is a difficult point of understanding to alter.…”

“…The bitter taste of isoniazid and the size of the tablet provided further difficulties when encouraging children to take their medication in multiple studies . Shorter, 3–4‐month regimens combining rifamycin antibiotics and isoniazid have recently been developed and shown to be safe and effective in children with improved adherence, while dissolvable, flavoured dose combinations have been used in active TB treatment since 2016 .…”