Barriers to screening and isoniazid preventive therapy for child contacts of tuberculosis patients

Belgaumkar, Vasudha Abhijit; Chandanwale, Ajay; Valvi, Chhaya; Pardeshi, Geeta; Lokhande, Rahul; Kadam, Dileep; Joshi, Samir; Gupte, Nikhil; Jain, Deepali; Dhumal, Gauri; DeLuca, Andrea; Golub, Jonathan E.; Gupta, Amita; Kinikar, Aarti; Bollinger, Robert C.

doi:10.5588/ijtld.17.0848

Cited by 20 publications

(26 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29 These findings are concordant with those of a study done in South Africa which cited lack of experience, knowledge, and clarity on the benefits of IPT and existing guidelines by HCWs as important barriers for IPT provision rather than patient-related factors. 48 Similarly, inadequate knowledge and training of health-care providers and poor monitoring mechanism in the programme were noted as key bottlenecks in the provision of IPT in India. 49 In Kigali, Rwanda, unfriendly health-care providers were highlighted as a key barrier in utilisation of IPT.…”

Section: Discussionmentioning

confidence: 99%

“…In line with this, a study showed that the belief that existing screening tools are inaccurate in HIV-infected individuals and the need to refer patients to separate clinics for tuberculosis screening has been shown to be barriers in utilization. 48 Besides, the attendant lack of experience in administering IPT among HCW may also be a contributor to the low rates of prescription of IPT. One strategy to counter this could be use of 'IPT champions' who would set an example by prescribing IPT thus promoting other HCW to follow suit.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study

Mwangi

Wamalwa

Marangu

et al. 2019

EAHRJ

View full text Add to dashboard Cite

Background: HIV is the strongest risk factor for developing tuberculosis (TB) among people with latent or new Mycobacterium tuberculosis infection. Isoniazid preventive therapy (IPT) reduces the risk of active TB among people living with HIV by up to 62%. Despite evidence that IPT is safe and efficacious, its provision remains low globally. The current study aimed at documenting IPT uptake, adherence, and completion rates, as well as the correlates of IPT uptake among HIV-infected children in Kenya. The study also assessed the knowledge, attitude, and practices of health-care workers (HCWs) with regard to IPT. Methods: A health facility-based cross-sectional study was conducted. Data were collected from caregivers of HIV-infected children as well as HCWs using an interviewer-administered questionnaire. Logistic regression was used to determine the factors associated with IPT uptake. Results: The study enrolled 111 child-caregiver dyads. Most of the caregivers were female (n=75, 77.3%) and HIV-positive (n=82, 85.4%). The majority of children were male (n=65, 58.6%) and on ART (n=106, 95.5%). Overall, 59 children were on IPT (uptake of 53.2%, 95% confidence interval [CI], 43.9% to 62.4%). Out of the 25 children who had been on IPT for more than 6 months, 22 (88.0%) successfully completed the 6-month course of treatment. Further, 27 of the 34 children (78.4%) who were on IPT at the time of the study demonstrated satisfactory adherence to the therapy (no doses missed). The caregivers' attributes that were associated with IPT uptake included having a secondary school education (adjusted odds ratio [aOR] 0.13; 95% CI, 0.03 to 0.67) and having been on IPT (aOR 27.50; 95% CI, 5.39 to 140.28). The characteristics of children that were significantly associated with IPT uptake were higher median baseline CD4 count (P=.007) and higher median current CD4 count (P=.024). Conclusion: The study demonstrated suboptimal IPT uptake but favourable adherence and treatment completion rates. There was almost universal awareness of IPT within the study sample. Furthermore, the majority of the HCWs had a favourable attitude towards IPT. However, the attendant IPT practices were inadequate, with majority of HCWs reporting that they had never initiated IPT, prescribed IPT within the last 12 months, or renewed an isoniazid prescription.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study

Mwangi

Wamalwa

Marangu

et al. 2019

EAHRJ

View full text Add to dashboard Cite

show abstract

“…Our study showed that delay or no contact screening and delay in initiation of therapy were identified as the barriers by parents or caretakers whose children were not enrolled in therapy. A study from India by Belgaumkar et al too has underlined similar findings where paramedical health workers were not identifying and referring eligible children for TB screening and IPT as per the national TB guidelines [ 14 ]. The WHO recommends clinical evaluation of household contacts of SS+ cases for active TB.…”

Section: Discussionmentioning

confidence: 98%

Implementation fidelity of tuberculosis preventive therapy for under five children exposed to sputum smear positive pulmonary tuberculosis in Kaski district, Nepal: An implementation research

et al. 2022

View full text Add to dashboard Cite

Introduction In line with the WHO recommendation, Nepal has started implementing Tuberculosis prevention therapy (TBPT) for under five children exposed to Sputum Smear Positive Pulmonary Tuberculosis, as one of the strategies for prevention, care and control of TB. Implementation fidelity study is important to assess on what extent preventive program is being implemented. The objective of the study measured the implementation fidelity of TBPT program Kaski district, Nepal. Methods We used a mixed-method explanatory sequential design study. Quantitative data were collected through retrospective review of records from April 2018 to May 2019 and level of adherence was established. Moderating factors influencing the implementation of TBPT were TBPT were assessed qualitatively. Sixteen in-depth interviews and a focus group discussion was conducted purposively with responsible stakeholders. The study was guided by the Conceptual Framework for Implementation Fidelity (CFIR) developed by Carroll. Results The majority of the components of the TBPT program were found to be implemented with a moderate level of fidelity. The proportion of under five years children initiate and complete the full course of TBPT was 72.5% and 75.86% respectively. The proportion of index cases traced for household contact, contact tracing within two months and timely initiation of therapy within two months were 54.19%, 82.73% and 86.20%. Moderating factors identified in the implementation of the program were contact tracing and enrollment, partnership and ownership, training resources, medication, awareness and information dissemination. Conclusion The TBPT program is being moderately implemented in Kaski districts. Addressing the key challenges identified in contact tracing, partnership/ownership, incentives, training and knowledge of health workers results in more identification of children eligible for TBPT.

show abstract

“…A qualitative study carried out in Lesotho faced a similar challenge such as cost transportation due to the long distance to clinics from remote areas and stigma as the key challenge in pediatric contact investigation [ 9 ]. A study carried out by Belgaumber et al also suggested that stigma-related disclosure is one of the predominant barriers faced in pediatric contact screening [ 15 ]. Extensive education through electronic media and innovative campaigns involving schools as well as non-governmental organizations could be the best strategy to approach the masses.…”

Section: Discussionmentioning

confidence: 99%

Challenges Perceived by Health Care Providers for Implementation of Contact Screening and Isoniazid Chemoprophylaxis in Karnataka, India

et al. 2021

View full text Add to dashboard Cite

Background: In India, challenges in pediatric TB contact screening and chemoprophylaxis initiation are still underexplored. Elucidating these challenges will help in better implementation of the programme at the grass-roots level thereby helping in early detection of pediatric cases and timely initiation of preventive therapy. This study aimed at exploring the challenges faced by the health care provider in contact screening and chemoprophylaxis initiation implementation of the pediatric household contacts. Methods: A qualitative study was conducted in the districts of Bengaluru and Udupi and in-depth interviews of key participants were adopted to explore the challenges. Qualitative data analysis was done after developing transcripts by generating themes and codes. Results: The key challenges were identified as stigma towards the disease, migrant patients with changing address, difficulty in sample collection, anxiety among parents due to long duration of the prophylactic treatment and adherence to IPT is not well documented, inadequate transportation from rural areas, and the ongoing COVID-19 pandemic. Conclusions: It is important for the National TB programme to address these challenges efficiently and effectively. Innovative solutions, feasible engagements, and massive efforts are to be taken by the programme to improve contact screening and isoniazid chemoprophylaxis implementation.

show abstract

Barriers to screening and isoniazid preventive therapy for child contacts of tuberculosis patients

Cited by 20 publications

References 0 publications

Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study

Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study

Implementation fidelity of tuberculosis preventive therapy for under five children exposed to sputum smear positive pulmonary tuberculosis in Kaski district, Nepal: An implementation research

Challenges Perceived by Health Care Providers for Implementation of Contact Screening and Isoniazid Chemoprophylaxis in Karnataka, India

Contact Info

Product

Resources

About