Adherence to isoniazid preventive therapy in children exposed to tuberculosis: a prospective study from Guinea-Bissau

Gomes, Vera Lúcia de Oliveira; Wejse, Christian; Oliveira, Isabel; Andersen, Andreas; Vieira, Fina; Carlos, Luis; Vieira, Cesaltina S; Aaby, Péter; Gustafson, Per

doi:10.5588/ijtld.10.0558

Cited by 36 publications

(42 citation statements)

References 14 publications

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“…In our study, in both age groups the strongest risk factor for non‐completion of IPT was being contact of an index case with treatment outcome other than success. This could be a spurious finding related to index case and contact moving to a new address, which was a frequent cause of not completing contact evaluation in a study in Guinea Bissau and elsewhere too . Yet, competing priorities in the household, or other factors impacting on discontinuation of TB care in the household, such as substance abuse, could also explain this .…”

Section: Discussionmentioning

confidence: 99%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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Objective Contacts of pulmonary tuberculosis (TB) cases are at high risk of TB infection and progression to disease. Close and household contacts and those <5 years old have the highest risk. Isoniazid preventive therapy (IPT) can largely prevent TB disease among infected individuals. International and Peruvian recommendations include TB contact investigation and IPT prescription to eligible contacts. We conducted a study in Lima, Peru, to determine the number of close and household contacts who were evaluated, started on IPT, and who completed it, and the factors associated to compliance with national guidelines. Methods We conducted a longitudinal retrospective study including all TB cases diagnosed between January 2015 and July 2016 in 13 health facilities in south Lima. Treatment cards, TB registers and clinical files were reviewed and data on index cases (sex, age, smear status, TB treatment outcome), contact investigation (sex, age, kinship to the index case, evaluations at month 0, 2 and 6) and health facility (number of TB cases notified per year, proportion of TB cases with treatment success) were extracted. We tabulated frequencies of contact evaluation by contact and index case characteristics. To investigate determinants of IPT initiation and completion, we used generalised linear mixed models. Results A total of 2323 contacts were reported by 662 index cases; the median number of contacts per case was four (IQR, 2–5). Evaluation at month 0 was completed by 99.2% (255/257) of contacts <5 and 98.1% (558/569) of contacts aged 5–19 years. Of 191 eligible contacts <5 years old, 70.2% (134) started IPT and 31.4% (42) completed it. Of 395 contacts 5–19 years old, 36.7% (145) started IPT and 32.4% (47) completed it. Factors associated to not starting IPT among contacts <5 years old were being a second‐degree relative to the index case (OR 6.6 95CI% 2.6–16.5), not having received a tuberculin skin test (TST) (OR 3.9 95%CI 1.4–10.8), being contact of a smear‐negative index case (OR 5.5 95%CI 2.0–15.1) and attending a low‐caseload health facility (OR 2.8 95%CI 1.3–6.2). Factors associated to not starting IPT among 5–19 year‐olds were age (OR 13.7 95%CI 5.9–32.0 for 16‐19 vs. 5–7 years old), being a second‐degree relative (OR 3.0 95%CI 1.6–5.6), not having received a TST (OR 5.4, 95%CI 2.5–11.8), being contact of a male index case (OR 2.1 95CI% 1.2–3.5), with smear‐negative TB (OR 1.9 95%CI 1.0–3.6), and attending a high‐caseload health facility (OR 2.1 95%CI 1.2–3.6). Factors associated to not completing IPT, among contacts who started, were not having received a TST (OR 3.4 95%CI 1.5–7.9 for <5 year‐olds, and OR 4.3 95%CI 1.7–10.8 for those 5–19 years old), being contact of an index case with TB treatment outcome other than success (OR 9.3 95%CI 2.6–33.8 for <5 year‐olds and OR 15.3 95%CI 1.9–125.8 for those 5–19 years old), and, only for those 5–19 years old, attending a health facility with high caseload (OR 3.2 95%CI 1.4–7.7) and a health facility with low proportion of TB cases with treatment succ...

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Section: Discussionmentioning

confidence: 99%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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“…However, as in our study, adherence to therapy was poor in settings where the disease is endemic (range: 15 to 76%). 6,7,[34][35][36][37] In our study, poor staff knowledge of isoniazid preventive therapy and poor compliance with guidelines were found to be barriers to the initiation of therapy. Similar barriers have been reported in other countries: in India, health-care workers reported that unclear guidelines on child contact management inhibited their ability to implement therapy; 38 in Thailand, doctors were reluctant to initiate therapy due to concerns about isoniazid toxicity and resistance; 22 in Australia, doctors actively advised patients not to use isoniazid preventive therapy; 34 in the United States of America, medical graduates did not believe isoniazid preventive therapy was protective against disease progression; 39 and, in Malawi, health-care workers felt that screening child contacts by chest radiography was not worthwhile.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] Previously we presented a public health evaluation framework that involved situational, gap and options analyses and that could be used to identify problem areas and to develop appropriate multi-targeted solutions. 10 In this paper we present the findings of the first two stages of a public health evaluation carried out using this framework in Bandung, West Java, Indonesia.…”

Section: Introductionmentioning

confidence: 99%

Management of children exposed toMycobacterium tuberculosis: a public health evaluation in West Java, Indonesia

Rutherford

Ruslami

Anselmo

et al. 2013

Bull. World Health Organ.

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“…We have shown in Guinea Bissau that adherence to IPT can be quite high 28 and that IPT in children in households with a recent case of TB lowers mortality. 29 However, a recent cluster randomized trial among 78 744 miners of three gold-mining companies in South Africa showed that IPT had only a short-lasting effect on overall TB incidence in this high-risk population with a high HIV prevalence.…”

Section: Preventive Therapy Of Latent Tuberculosismentioning

confidence: 97%

Tuberculosis elimination in the post Millennium Development Goals era

Wejse

2015

International Journal of Infectious Diseases

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The Millennium Development Goal for tuberculosis (TB) is to stop the increase in incidence and halve the mortality of TB between 1990 and 2015. This goal has now been reached on a global scale, although not in the most affected region of Africa. The new target is TB elimination, defined as one case of active TB per one million population per year, which is to be reached before 2050. This review will discuss the main tools in play, namely case-finding and new diagnostics, increased access and effectiveness of anti-TB therapy (directly observed therapy, short course (DOTS)), preventive therapy for latent infection, and vaccination. Each approach is discussed and a way forward in research and management is suggested.

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Adherence to isoniazid preventive therapy in children exposed to tuberculosis: a prospective study from Guinea-Bissau

Abstract: Overall adherence to IPT was better than previously reported from TB-endemic areas, with 76% of the children completing at least 6 months of treatment, with more than 80% adherence.

Cited by 36 publications

References 14 publications

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Management of children exposed toMycobacterium tuberculosis: a public health evaluation in West Java, Indonesia

Tuberculosis elimination in the post Millennium Development Goals era

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