Challenges to delivery of isoniazid preventive therapy in a cohort of children exposed to tuberculosis in Timor‐Leste

Abstract

Abstractobjectives To evaluate the number and geographic location of children aged <5 years exposed to sputum smear-positive tuberculosis (TB) in Timor-Leste, to determine the proportion evaluated for isoniazid preventive therapy (IPT) and to review the programmatic challenges present in delivering IPT to this cohort.methods A total of 256 consecutive sputum smear-positive TB index cases diagnosed at Bairo Pite Clinic between August 2013 and July 2014 were interviewed about places of residence and household contacts <5 years of age in the 3 months preceding diagnosis. Attendance of these contacts for screening and the outcome of screening were recorded prospectively.results The majority (225 of 256, 88%) of index cases resided in Dili, but 73 of 225 (32%) of these also had a second address outside the capital. A total of 255 contacts were identified; 172 of 255 (67%) of whom lived in Dili district and 83 of 255 (33%) of whom resided in remote districts. Only 66 of 255 (26%) contacts attended for evaluation for IPT, of whom 46 of 255 (18%) started IPT and nine of 255 (3.5%) were diagnosed with TB. Attendance was significantly less likely when the index case was not the parent of the child contact.conclusions Sputum smear-positive pulmonary TB cases frequently result in household exposure of children <5 years in Timor-Leste, and provision of IPT is suboptimal. Contacts are located in diverse and distant locations. Further studies to delineate access barriers to IPT and review programmatic models that will facilitate IPT scale up in Timor-Leste are needed.

Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study

“…Additionally, as compared to our study, a slightly higher IPT initiation rate was reported in South Africa and Ethiopia where initiation of IPT was done in 68% 25 and 64% 26 of the children who were eligible for IPT, respectively. On the other hand, the uptake of IPT in our study was higher than the 37% reported in Ethiopia, 27 33% rate in southern India, 28 the 18% demonstrated in Timor-Leste, 29 the 6% reported in a Malawian study 30 and 22% in Bhopal, India. 31 The high variations in the findings most probably is a reflection of the contextual differences in the settings where the studies were carried out.…”

BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing

“…Although previous studies have demonstrated this potential [22], studies have also demonstrated significant challenges linking new cases to prompt treatment [29] and consistently low uptake of preventive TB treatment [30–35]. Similarly, only 25% of eligible contacts evaluated by our program initiated IPT.…”

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 .…”

“…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.…”

“…In order for patients and caregivers to be better informed about their health risks and treatment options, health‐care workers must be knowledgeable and educated about the medications and services they offer, prescribe and monitor. A large proportion of the studies reviewed showed that this was generally not the case, with significant gaps in health‐care worker knowledge about the nature and benefits of IPT . This translates into poor understanding and poor uptake by patients.…”