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Adherence to isoniazid preventive therapy among child contacts in Rwanda: A mixed-methods study
Francine Mwayuma Birungi1,2, Stephen Michael Graham3,4, Jeannine Uwimana1,5
1Department of Epidemiology and Biostatistics, School of Public Health of the College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Plos One
|February 12, 2019
Summary
High adherence to isoniazid preventive therapy (IPT) was observed in child contacts in Rwanda. Structural factors like poverty and relocation were key barriers to completing IPT, highlighting areas for healthcare provider intervention.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Pediatric Health
Background:
- The World Health Organization (WHO) recommends a six-month isoniazid preventive therapy (IPT) for child contacts exposed to active tuberculosis (TB).
- Effective TB prevention in children relies on high medication adherence, with 80% or greater adherence being a critical threshold for IPT success.
- Assessing adherence and understanding its determinants in vulnerable populations is crucial for optimizing TB control strategies.
Purpose of the Study:
- To evaluate the adherence rates to isoniazid preventive therapy (IPT) among eligible child contacts in Kigali, Rwanda.
- To identify barriers and facilitators influencing IPT adherence in this pediatric cohort.
- To inform targeted interventions for improving TB prevention adherence in similar settings.
Main Methods:
- A mixed-methods study combining a quantitative observational cohort design with a qualitative descriptive study.
- Prospective assessment of IPT adherence among child contacts.
- Exploration of adherence-related factors through qualitative interviews with parents/caregivers and healthcare providers.
Main Results:
- A high complete adherence rate of 88% was observed among 84 child contacts initiating IPT.
- No significant associations were found between individual, household, or health facility characteristics and IPT adherence in quantitative analyses.
- Qualitative findings identified parental/caregiver factors, disease characteristics, household conditions, and healthcare provider interactions as key determinants of adherence.
Conclusions:
- The study demonstrated a high rate of IPT completion among eligible child contacts in Kigali.
- Structural barriers, including poverty and relocation, emerged as primary obstacles to IPT adherence.
- Healthcare providers play a vital role in addressing these structural challenges to improve medication adherence for TB prevention in children.
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