Tuberculosis contact investigation and short-course preventive therapy among young children in Africa

Area of Science:

• Public Health
• Infectious Diseases
• Pediatrics

Background:

• Tuberculosis (TB) prevention in high-burden, resource-limited settings remains a challenge.
• Household contact investigation is crucial for identifying individuals at high risk of TB infection.
• Effective preventive strategies are needed for young children exposed to infectious TB cases.

Purpose of the Study:

• To assess the feasibility of household contact investigation for tuberculosis (TB).
• To evaluate the effectiveness of TB preventive therapy in young children in resource-limited urban areas.
• To compare two TB preventive regimens: 3-month rifampicin-isoniazid (3RH) and 6-month isoniazid (6H).

Main Methods:

• Screening of children under 5 years living with adults diagnosed with pulmonary TB.
• Utilized questionnaires, clinical exams, tuberculin skin tests, and chest X-rays for diagnosis.
• Offered 3RH or 6H preventive therapy, with comprehensive follow-up and cost coverage.

Main Results:

• 1965 children were enrolled; 2.8% had prevalent TB at baseline.
• 91% of eligible children initiated preventive therapy, with a 94% completion rate.
• Mild adverse reactions (2%) were reported; one incident TB case occurred after 3RH completion.

Conclusions:

• Household contact investigation and TB preventive therapy are successfully implementable in resource-limited urban settings.
• The 3-month rifampicin-isoniazid (3RH) regimen is a viable and effective alternative to the 6-month isoniazid (6H) regimen for TB prevention.
• Programmatic conditions with minimal additional resources can support effective TB control strategies.