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Published on: August 16, 2021
Does an isoniazid prophylaxis register improve tuberculosis contact management in South African children?
Nelda van Soelen1, Karen du Preez, Susan S van Wyk
1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
Insights
Implementing an isoniazid preventive therapy (IPT) register improved the identification and treatment of child contacts for tuberculosis (TB). The register also enhanced documentation of IPT adherence in children exposed to TB.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Pediatric Tuberculosis
Background:
- Child household contacts of tuberculosis (TB) cases are at high risk of infection.
- Effective management of these contacts is crucial for TB control, especially in high-burden settings.
- Isoniazid preventive therapy (IPT) is a key intervention for preventing TB in children.
Purpose of the Study:
- To evaluate the impact of an isoniazid preventive therapy (IPT) register on the management of child contacts of TB cases.
- To determine if the IPT register increased the identification of child contacts per infectious case.
- To assess if the IPT register improved the initiation and adherence to IPT among identified child contacts.
Main Methods:
- A comparative study analyzing routine program data before and after the implementation of an IPT register.
- Data review focused on two distinct periods: May-October 2008 (pre-register) and May-October 2011 (post-register).
- The setting was an urban clinic in Cape Town, South Africa, serving a population with a high TB burden.
Main Results:
- The implementation of the IPT register was associated with a significant increase in the identification of child contacts per adult TB case (0.7 vs. 0.3).
- More identified child contacts were initiated on IPT post-register implementation (54 vs. 4).
- Documentation of IPT adherence improved, with 37% of children completing six months of treatment in the post-register period, compared to no recorded adherence data previously.
Conclusions:
- The pilot implementation of an IPT register successfully enhanced the documented identification, IPT initiation, and adherence monitoring for TB-exposed children.
- Standardized IPT recording and reporting through registers show potential for improving TB prevention strategies targeting young children in high-burden areas.
- Systematic and comprehensive efforts are needed to integrate and sustain improved IPT delivery practices within routine TB programs.
Setting:
We compared the change in child household contact management of pulmonary tuberculosis (TB) cases before and after the implementation of an isoniazid preventive therapy (IPT) register in an urban clinic setting in Cape Town, South Africa.
Objectives:
We determined if the presence of an IPT register was associated with an increase in the number of child contacts identified per infectious case and the proportion of identified children who were started on IPT.
Design:
We reviewed routine programme data on IPT delivery to children during two time periods (May 2008-October 2008 and May 2011-October 2011), before and after the implementation of an IPT register used by routine clinic personnel.
Results:
Adult TB case demographic and clinical characteristics from the two observation periods were similar. During the post-register period, more child contacts per adult case were identified (0.7 (54 children) vs. 0.3 (24 children)), more of the identified children were started on IPT (54 vs. 4) and 37% of those who started, completed six months of treatment compared to the pre-register period where no adherence information was recorded.
Conclusions:
After pilot implementation of an IPT register, documented identification of child contacts, IPT initiation and IPT adherence documentation in TB exposed children was improved. Our findings support further exploration of the potential impact of using standardised IPT recording and reporting in routine clinics in high-burden TB settings to improve TB prevention efforts targeted at young children. Future efforts to improve IPT delivery should be systematic and comprehensive in order to support a change in current operational IPT delivery practices in TB programs.
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