Adherence to isoniazid preventive chemotherapy: a prospective community based study

Abstract

Background: Current international guidelines recommend 6-9 months of isoniazid (INH) preventive chemotherapy to prevent the development of active tuberculosis in children exposed to a susceptible strain of M tuberculosis. However, this is dependent on good adherence and retrospective studies have indicated that adherence to unsupervised INH preventive chemotherapy is poor. Aim: To prospectively document adherence to six months of unsupervised INH monotherapy and outcome in children with household exposure to an adult pulmonary tuberculosis index case. Methods: From February 2003 to January 2005 in two suburbs of Cape Town, South Africa, all children ,5 years old in household contact with an adult pulmonary tuberculosis index case were screened for tuberculosis and given unsupervised INH preventive chemotherapy once active tuberculosis was excluded. Adherence and outcome were monitored. Results: In total, 217 index cases from 185 households were identified; 274 children ,5 years old experienced household exposure, of whom 229 (84%) were fully evaluated. Thirty eight children were treated for tuberculosis and 180 received preventive chemotherapy. Of the children who received preventive chemotherapy, 36/180 (20%) completed >5 months of unsupervised INH monotherapy. During the subsequent surveillance period six children developed tuberculosis: two received no preventive chemotherapy, and four had very poor adherence. Conclusion: Adherence to six months of unsupervised INH preventive chemotherapy was poor. Strategies to improve adherence, such as using shorter duration multidrug regimens and/or supervision of preventive treatment require further evaluation, particularly in children who are at high risk to progress to disease following exposure.

Management of children exposed toMycobacterium tuberculosis: a public health evaluation in West Java, Indonesia

“…[5][6][7][8][9] Previously we presented a public health evaluation framework that involved situational, gap and options analyses and that could be used to identify problem areas and to develop appropriate multi-targeted solutions. 10 In this paper we present the findings of the first two stages of a public health evaluation carried out using this framework in Bandung, West Java, Indonesia.…”

An assessment of the isoniazid preventive therapy programme for children in a busy primary healthcare clinic in Nelson Mandela Bay Health District, Eastern Cape Province, South Africa

“…However, the number of child contacts per index patient (mean 0.53 (0.8)) was lower than that in previous studies (0.7 -1.3 child contacts per infectious TB case). [11][12][13][14][15] The study site relies on passive contact tracing, i.e. index patients are requested to bring their contacts to the clinic for screening; they are not actively traced by a healthcare worker.…”

“…Caregivers' perception that a child who is well does not need medication, interfered with IPT provision in previous studies. [11,18,19] This perception, compounded by the system of passive contact tracing, could have a significant negative effect on IPT provision in this setting. The fall-out of child contacts could also relate to the screening methods used.…”

“…[34] The WHO and NDoH recommend a 6-month course of INH to prevent TB in child contacts; [22,25] however, adherence rates are poor with this regimen. [10,11,15] Contacts in this study collected IPT for a median (IQR) number of 8 (11.25) weeks. Only 4 (3.7%) contacts completed the course.…”

“…Since 2008, these guidelines have recommended a symptom-based screening approach that does not require a skin test or chest radiograph in an asymptomatic child, as recommended in earlier guidelines. [9] However, contact tracing, screening and IPT initiation have been poorly implemented in areas of SA [10][11][12][13][14][15] and other low-and middleincome countries. [16][17][18][19] In Malawi, operational challenges such as high 2 =8.98; p=0.003; OR 0.41; 95% CI 0.24 -0.72).…”