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Gaps in the tuberculosis preventive therapy care cascade in children in contact with TB
E Van Ginderdeuren1,2, J Bassett1, C F Hanrahan3
1Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
Insights
Low uptake and adherence to TB preventive therapy (TPT) in child contacts hinder tuberculosis prevention. Most eligible children do not attend clinics, and half who start TPT do not complete the course, missing crucial opportunities for early diagnosis and disease prevention.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Young children and those with HIV exposed to tuberculosis (TB) require TB preventive therapy (TPT).
- Uptake of TPT in these vulnerable pediatric populations remains suboptimal.
Purpose of the Study:
- To identify gaps in the uptake and adherence to TPT among child TB contacts in a primary care setting.
- To evaluate TPT delivery under routine clinical conditions.
Main Methods:
- A cohort study followed child TB contacts (under 5 years or living with HIV under 15 years) at a primary care clinic in Johannesburg, South Africa.
- Data collection focused on TPT eligibility screening, initiation, and completion rates, alongside adherence factors.
Main Results:
- Only 45% of eligible child contacts attended for TPT screening.
- Of those initiating TPT, only 52% completed the 6-month course.
- While screening for TB symptoms was high, microbiological testing was low, and no cases of confirmed TB were found in symptomatic children.
Conclusions:
- Significant programmatic failures exist in TPT uptake and adherence among child TB contacts.
- These failures represent missed opportunities for preventing active TB and disease progression in young children and those with HIV.
Background:
Young children (<5 years) and children living with HIV in contact with an adult with tuberculosis (TB) should receive TB preventive therapy (TPT), but uptake is low.
Aims:
To determine gaps in the uptake of and adherence to TPT in child TB contacts under routine primary care clinic conditions.
Methods:
A cohort of child TB contacts (age <5 years or living with HIV <15 years) was followed at a primary care clinic in Johannesburg, South Africa.
Results:
Of 170 child contacts with 119 adult TB cases, only 45% (77/170) visited the clinic for TPT eligibility screening, two of whom had already initiated TPT at another clinic. Of the 75 other children, 18/75 (24%) commenced TB treatment and 56/75 (75%) started TPT. Health-care workers followed the guidelines, with 96% (64/67) of children screened for symptoms of TB and 97% (36/37) of those symptomatic assessed for TB, but microbiological testing was low (9/36, 25%) and none had microbiologically confirmed tuberculosis. Only half (24/46, 52%) of the children initiating TPT completed the 6-month course. Neither sociodemographic determinants (age, sex) nor clinical factors (HIV status, TB source, time to TPT initiation) was associated with non-adherence to TPT.
Conclusion:
Most child contacts of an adult TB case do not visit the clinic, and half of those initiating TPT did not adhere to the full 6-month course. These programme failures result in missed opportunities for early diagnosis of active TB and prevention of progression to disease in young and vulnerable children.
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