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Updated: Apr 3, 2026
An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
Published on: March 30, 2014
Routine programmatic delivery of isoniazid preventive therapy to children in Cape Town, South Africa
M Osman1, A C Hesseling2, N Beyers2
1City Health Directorate, City of Cape Town, Cape Town, South Africa.
Insights
Contact tracing for children exposed to infectious tuberculosis (TB) is insufficient. Few eligible children initiate and complete isoniazid preventive therapy (IPT), highlighting a critical gap in pediatric TB prevention.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly affecting vulnerable populations like young children.
- Identifying and treating child contacts of infectious adult TB cases is crucial for preventing secondary infections and transmission.
- Isoniazid preventive therapy (IPT) is a key strategy for TB prevention in children exposed to TB.
Purpose of the Study:
- To assess the proportion and characteristics of infectious adult TB cases that identify child contacts (<5 years) eligible for IPT.
- To determine the rates of IPT initiation and completion among identified child contacts.
- To identify factors associated with the documentation of child contacts in adult TB cases.
Main Methods:
- Retrospective clinical record review.
- Stratified cluster survey design.
- Conducted in 14 primary health care facilities in Cape Town, South Africa.
Main Results:
- Only 66.7% of infectious adult TB case records documented child contacts.
- Approximately 0.7 child contacts (<5 years) were identified per infectious adult case.
- Less than half of identified child contacts were screened for TB; 141 initiated IPT, but only 19 completed the full 6-month course.
Conclusions:
- Significant gaps exist in identifying and managing child contacts of infectious adult TB cases.
- Factors such as older age, male sex, HIV-positive status, smear-negative, and retreatment TB were associated with poor contact documentation.
- Low IPT completion rates among eligible children underscore the need for improved adherence support and program strategies.
Setting:
Fourteen primary health care facilities in Cape Town, South Africa.
Objective:
To determine the proportion and characteristics of infectious adult tuberculosis (TB) cases that identify children aged <5 years who qualify for isoniazid preventive therapy (IPT), and to determine the proportion of children who initiate and complete IPT.
Design:
A retrospective clinical record review conducted as a stratified cluster survey.
Results:
Of 1179 records of infectious adult cases, 33.3% had no documentation of contacts. Of the remaining 786 records, 525 contacts aged <5 years were identified, representing 0.7 child contacts per infectious adult case. Older age, male, human immunodeficiency virus (HIV) positive, smear-negative and retreatment TB cases were all associated with no documentation of contacts. Of the 525 child contacts identified, less than half were screened for TB, 141 initiated IPT and 19 completed it.
Conclusion:
Less than 67% of infectious TB case records had documentation of contacts. Younger, female, HIV-negative and new smear-positive TB cases were more likely to have had contacts identified. Less than 14% of children already initiated on IPT completed 6 months of treatment.
