Adherence to Isoniazid Preventive Therapy among Under-Five Children in Contact with Adult Bacteriologically Confirmed Pulmonary Tuberculosis Patients: A Mixed-Method Study

Abstract

Background. The World Health Organization recommends that all children below the age of five who have household contact with an infectious tuberculosis case should receive isoniazid preventive treatment for at least six months after the active tuberculosis disease has been ruled out. This research aims to determine the adherence of children, eligible for isoniazid preventive treatment, to the treatment who had contact with pulmonary tuberculosis patients. Methods. A mixed study design was used to prospectively assess the adherence to IPT among children under the age of 5 in contact with pulmonary TB patients through the quantitative study design and barriers of adherence in view of health care professionals and the family of children through a descriptive qualitative study. The study was conducted from July 2019 to December 2019 in Addis Ababa. Data were collected by a structured datasheet from the selected health center registration book. Data were entered into Epi Data software and analyzed by using SPSS version 20. Descriptive statistical methods were used to summarize the sociodemographic characteristics of the study participants. Result. The ratio of the total number of pulmonary tuberculosis index cases recruited into the study to the number of child contacts aged less than 5 years was 1 : 1.32. The total isoniazid preventive treatment uptake in this study was 75.2%; one-fifth (21.3%) of the children who started IPT did not complete the full course of six-month isoniazid preventive treatment. Except for HIV not to be tested ( P < 0.001 ), there was no significant association of the listed risk factors in default to complete the full six months of preventive treatment. Conclusion. Enrolment of eligible children for isoniazid preventive treatment in the urban city Addis Ababa was still below the target of the World Health Organization End tuberculosis strategy by 2030. The treatment adherence rate also needs a great deal of effort to achieve the strategy. Child default after the first visit indicates a lack of understanding about the benefit and safety of preventive therapy in young children among families of TB patients, and awareness-creating efforts by health extension workers will help to improve the outcomes.

Completion of 6-mo isoniazid preventive treatment among eligible under six children: A cross-sectional study, Lagos, Nigeria

“…This means that age, gender, and type of facility did not influence the treatment completion of INH recorded among the children. These findings are similar to reports from Guinea-Bissau and Ethiopia where there was no significant association of the listed risk factors, including sociodemographic variables, on the completion of the full six months of isoniazid preventive treatment[ 23 , 26 ].…”

“…Of the cumulative 107 children lost to follow up on INH, largest drop-offs were reported at the end of month two, 52 (49%) followed by 20 (19%), 17 (16%), 11 (10.2%) and 7 (6.5%) at months three, four, five and six respectively. This is similar to study in Ethiopia where majority, 6 (30%) of the 20 children who interrupted INH did so at month two[ 26 ] while in Milan, majority (15.2%) of INH drop-offs occurred between the start of treatment and the first follow up visit, although this was lower among those on shorter rifampicin containing regimen[ 27 ]. The study observed that the largest patient losses while on INH occurred within the first 2 mo of initiating INH which supports the imperative to target this early period of treatment, particularly by strengthening the initial adherence counseling and caregivers’ education on the importance of remaining adherent to INH for the entire six months of treatment.…”

Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries ‐ a systematic review and meta‐analysis

“…Collecting data from the programme registers and from reports that lack rigour in documenting the information could lead to selection bias for the number of household contacts. [32,38,52,53,62] Adherence to TPT The common factors related to TPT adherence included: higher cost of transportation, medication palatability, longer treatment duration, social support, and the knowledge and beliefs of HCWs and carers. Further, treatment adherence reported in the studies could be an overestimation as it depended on pill count or on the monthly collection of prescriptions.…”

Effect of Isoniazid Preventive Therapy on the Incidence of Tuberculosis among Seropositive Children Attending HIV/AIDS Care in Two General Hospitals, Northwest Ethiopia, 2021

“…Nevertheless, adherence to IPT completion rate is still a despairing issue. Notable factors like drug stock-out, a distance of health facilities, and drug side effects were some of the hindrances for recommended compilation rate [ 15 , 16 ]. There is a paucity of data for protecting and effective prevention of IPT on the incidence of active TB for children living with HIV during successive time cohorts.…”

“…Nevertheless, adherence to IPT completion rate is still a despairing issue. Notable factors like drug stock-out, a distance of health facilities, and drug side effects were some of the hindrances for recommended compilation rate [15,16].…”