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Isoniazid Preventive Therapy among Children Living with Tuberculosis Patients: Is It Working? A Mixed-Method Study
Akash Ranjan Singh1, Atul Kharate2, Prashant Bhat3
1Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India.
Insights
Isoniazid preventive therapy (IPT) uptake was low among child contacts of tuberculosis (TB) patients in India. Key barriers included parental awareness, screening issues, drug stock-outs, and provider knowledge.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis (TB) remains a significant global health threat, particularly impacting vulnerable populations like children.
- Isoniazid preventive therapy (IPT) is a crucial strategy to prevent TB in child contacts of infectious TB cases.
- Effective implementation of IPT programs is essential to reduce childhood TB incidence.
Purpose of the Study:
- To evaluate the uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive TB patients.
- To identify implementation challenges of IPT from the perspectives of healthcare providers and parents.
- To inform strategies for improving IPT coverage in high-burden settings.
Main Methods:
- A mixed-method study combining quantitative data from program records and surveys with qualitative data from interviews.
- Quantitative phase involved reviewing records and conducting house-to-house surveys of TB patients' child contacts.
- Qualitative phase included in-depth interviews with healthcare providers and parents of child contacts.
Main Results:
- Only 22% of eligible children started IPT and 20% completed the therapy.
- Significant barriers identified include low parental awareness and risk perception, a complex screening process, stock-outs of isoniazid, and inadequate healthcare provider knowledge.
- Poor programmatic monitoring was also highlighted as a major impediment to IPT implementation.
Conclusions:
- Strengthening IPT programs requires addressing parental counseling and healthcare provider training.
- Simplifying screening procedures and ensuring consistent isoniazid drug supply are critical.
- Implementing robust monitoring indicators is necessary to improve IPT uptake and effectiveness.
Objective:
We assessed uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive tuberculosis (TB) patients and its implementation challenges from healthcare providers' and parents' perspectives in Bhopal, India.
Methods:
A mixed-method study design: quantitative phase (review of programme records and house-to-house survey of smear-positive TB patients) followed by qualitative phase (interviews of healthcare providers and parents).
Results:
Of 59 child contacts (<6 years) of 129 index patients, 51 were contacted. Among them, 19 of 51 (37%) were screened for TB and one had TB. Only 11 of 50 (22%) children were started and 10 of 50 (20%) completed IPT. Content analysis of interviews revealed lack of awareness, risk perception among parents, cumbersome screening process, isoniazid stock-outs, inadequate knowledge among healthcare providers and poor programmatic monitoring as main barriers to IPT implementation.
Conclusion:
National TB programme should counsel parents, train healthcare providers, simplify screening procedures, ensure regular drug supply and introduce an indicator to strengthen monitoring and uptake of IPT.
