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Urine Biomarker Assessment of Infant Adherence to Isoniazid Prophylaxis

Sylvia M LaCourse1,2, Daniel Leon3, Nuttada Panpradist3

  • 1From the Division of Allergy and Infectious Diseases, Department of Medicine.

The Pediatric Infectious Disease Journal
|October 15, 2020
PubMed

Insights

Infant tuberculosis prevention adherence in Kenya was assessed using a urine test. Many infants tested positive despite caregivers reporting adherence, indicating potential self-medication and influencing adherence.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Pediatrics

Background:

  • Tuberculosis (TB) prevention in infants is crucial for controlling transmission.
  • Accurate adherence monitoring for infant TB preventive therapy is challenging.
  • Caregiver-reported adherence may not reflect actual medication intake.

Purpose of the Study:

  • To evaluate the utility of a urine isoniazid metabolite dipstick test for assessing infant adherence in a TB prevention trial.
  • To identify factors associated with adherence in infants receiving TB preventive therapy.

Main Methods:

  • A urine isoniazid metabolite-detecting dipstick assay was used to assess adherence in 97 infants in Kenya.
  • 155 urine assays were performed.
  • Data on caregiver-reported adherence and maternal factors were collected.

Main Results:

  • Nearly half (49.7%) of the urine assays were positive, contradicting caregiver-reported adherence.
  • Positive urine assays correlated with higher maternal education levels.
  • Positive results were also associated with maternal HIV suppression and fewer reported missed doses.

Conclusions:

  • The urine dipstick test offers an objective measure of infant adherence to TB preventive therapy.
  • Maternal education and self-medication practices may influence adherence.
  • Further research is needed to optimize adherence monitoring and intervention strategies in infant TB prevention.

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