Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya

Abstract

SettingChildren especially those <5 years of age exposed to pulmonary tuberculosis (TB) are at a high risk of severe TB disease and death. Isoniazid preventive therapy (IPT) has been shown to decrease disease progression by up to 90%. Kenya, a high TB burden country experiences numerous operational challenges that limit implementation of TB preventive services. IPT completion in child contacts is not routinely reported in Kenya.ObjectiveThis study aims to review the child contact management (CCM) cascade and present IPT outcomes across 10 clinics in western Kenya.DesignA retrospective chart review of programmatic data of a TB Reach-funded active, clinic-based CCM strategy.ResultsOf 553 child contacts screened, 231 (42%) were reported symptomatic. 74 (13%) of the child contacts were diagnosed with active TB disease. Of those eligible for IPT, 427 (90%) initiated IPT according to TB REACH project data while 249 (58%) were recorded in the IPT register with 49 (11%) recorded as a transfer to other facilities. Of the 249 recorded in the IPT register, 205 (82%) were documented to complete therapy (48% of project initiation children).ConclusionOur evaluation shows gaps in the routine CCM care cascade related to completeness of documentation that require further programmatic monitoring and evaluation to improve CCM outcomes.

Strategies to detect and manage latent tuberculosis infection among household contacts of pulmonary TB patients in high TB burden countries ‐ a systematic review and meta‐analysis

“…Collecting data from the programme registers and from reports that lack rigour in documenting the information could lead to selection bias for the number of household contacts. [32,38,52,53,62] Adherence to TPT The common factors related to TPT adherence included: higher cost of transportation, medication palatability, longer treatment duration, social support, and the knowledge and beliefs of HCWs and carers. Further, treatment adherence reported in the studies could be an overestimation as it depended on pill count or on the monthly collection of prescriptions.…”