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Published on: August 16, 2021
Children and providers' perspectives on once-weekly rifapentine and isoniazid TB preventive therapy
A J Marthinus1, D T Wademan1, Z Saule1
1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
The 12-week once-weekly rifapentine and isoniazid (3HP) regimen eased treatment burden for children and caregivers compared to the 6-month isoniazid (6H) regimen. However, optimal integration of 3HP requires education and adherence support for successful completion.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- Pharmacology
Background:
- Tuberculosis (TB) preventive treatment (TPT) is crucial for preventing disease progression in at-risk individuals.
- Implementation of TPT in children is suboptimal in high-burden settings, with challenges linked to the duration and pill burden of the standard 6-month isoniazid (6H) regimen.
- A 12-week once-weekly rifapentine and isoniazid (3HP) regimen in a dispersible tablet formulation was evaluated for pediatric use in South Africa.
Purpose of the Study:
- To explore the experiences of children, caregivers, and healthcare providers with the 3HP regimen for TPT in children.
- To identify potential barriers and facilitators to the implementation of the 3HP regimen in a high-burden setting.
Main Methods:
- A qualitative study involving serial, in-depth interviews with 20 child-caregiver dyads and 9 healthcare providers.
- Participants included children living with HIV (CLWH).
- Interviews were conducted across two study sites involved in a pharmacokinetic and safety trial of 3HP and analyzed deductively.
Main Results:
- Caregivers and healthcare providers preferred the 3HP regimen over the 6H regimen due to improved palatability and ease of preparation/administration.
- Concerns were raised regarding the integration of once-weekly 3HP dosing into routine clinical practice.
- Children living with HIV expressed a preference for the daily 6H regimen due to its simpler integration with daily antiretroviral therapy.
Conclusions:
- The 3HP regimen significantly reduces the treatment administration burden for children and their caregivers.
- Successful completion of the once-weekly 3HP regimen necessitates targeted education and adherence support strategies.
Background:
TB preventive treatment (TPT) prevents the development of TB disease in individuals at risk of progression from infection to disease. However, implementation of TPT for children is poor in most high-burden settings. The long duration and pill burden of the 6-month once-daily isoniazid regimen (6H) pose significant barriers to completion. We aimed to understand children's, caregivers', and healthcare providers' experiences of the 12-week once-weekly rifapentine and isoniazid (3HP) regimen using a dispersible tablet formulation in South Africa.
Methods:
Serial, in-depth qualitative interviews with 20 child-caregiver dyads, including 5 children living with HIV (CLWH) and 9 healthcare providers across two study sites implementing a pharmacokinetic and safety trial of 3HP, were analysed deductively.
Results:
Of those with experience using both 3HP and 6H, caregivers and healthcare providers preferred 3HP, and study participants reported that the 3HP formulation was more palatable and easier to prepare and administer. Caregivers and healthcare providers were concerned about optimally integrating 3HP into routine care, primarily due to its once-weekly administration. Children with HIV preferred the once-daily 6H regimen for its ease of use with their daily antiretroviral therapy.
Conclusions:
3HP reduced the administration burden for children and their caregivers. Once weekly, 3HP dosing will require education and adherence support to ensure completion.
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