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Adherence to isoniazid prophylaxis among HIV-infected children: a randomized controlled trial comparing two dosing

Stanzi M le Roux1, Mark F Cotton, Jonathan E Golub

  • 1School of Child and Adolescent Health, University of Cape Town, South Africa. stanzi.leroux@gmail.com

BMC Medicine
|November 6, 2009
PubMed

Insights

Adherence to isoniazid prophylaxis in HIV-infected children was excellent with both daily and three times weekly dosing. Intermittent dosing is a viable alternative to daily regimens, ensuring optimal adherence and efficacy for tuberculosis prevention.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Pediatrics

Background:

  • Tuberculosis (TB) significantly impacts HIV-infected children in sub-Saharan Africa.
  • Isoniazid prophylaxis reduces TB incidence but requires optimized adherence.
  • This study investigated adherence predictors for isoniazid in HIV-infected children.

Purpose of the Study:

  • To compare adherence to daily versus three times weekly isoniazid prophylaxis in HIV-infected children.
  • To identify predictors of adherence to isoniazid prophylaxis in this population.

Main Methods:

  • A randomized trial at two tertiary pediatric centers in Cape Town, South Africa.
  • 324 HIV-infected children aged >or= 8 weeks were followed for 5 years.
  • Adherence assessed via pill counts; >or= 90% considered optimal; logistic regression with GEE used.

Main Results:

  • Overall adherence was excellent (94.7%), with no significant difference between daily (93.8%) and thrice-weekly (95.5%) schedules.
  • 78.6% of children achieved optimal adherence (>or= 90%).
  • Overcrowded homes predicted lower adherence; older children (>4 years) showed better adherence.

Conclusions:

  • Excellent isoniazid adherence is achievable with both daily and intermittent (3x/week) dosing schedules.
  • Intermittent isoniazid prophylaxis is a suitable alternative to daily dosing for TB prevention in HIV-infected children.
  • Adherence is influenced by socioeconomic factors and age.
Abstract

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