Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review

Grace, Samuel G

doi:10.1111/jpc.14359

Cited by 16 publications

(18 citation statements)

References 31 publications

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“…In this study, there was a trend of virally non‐suppressed CLHIV being less likely to initiate IPT suggesting that they could have been sicker at enrolment, thus their providers may not have felt confident in ruling out active TB. The impact of caregiver barriers, such as the cost of travel for IPT services and the perception of minimal risk in asymptomatic children [ 28 ], may have also contributed.…”

Section: Discussionmentioning

confidence: 99%

“…Attending high-volume HIV clinics (aRR = 2.82; 95% CI 1.20-6.62) was independently associated with IPT non-initiation. IPT non-initiation had a trend of being higher among those enrolled in the period -2019 versus 2015 0.98-3.73) and those who were HIV virally non-suppressed (aRR = 1.90; 95% CI 0.98-3.71). Being enrolled in -2019 versus 2015 1.01-1.96) was independently associated with IPT non-completion.…”

mentioning

confidence: 97%

“…IPT non-initiation had a trend of being higher among those enrolled in the period -2019 versus 2015 0.98-3.73) and those who were HIV virally non-suppressed (aRR = 1.90; 95% CI 0.98-3.71). Being enrolled in -2019 versus 2015 1.01-1.96) was independently associated with IPT non-completion. By 24 months after IPT screening, TB incidence was four-fold higher among eligible CLHIV who never initiated (8.1 per 1000 person years [PY]) compared to CLHIV who completed IPT (2.1 per 1000 PY; rate ratio [RR] = 3.85; 95% CI 1.08-17.15), with a similar trend among CLHIV who initiated but did not complete IPT (8.2/1000 PY; RR = 4.39; 95% CI 0.82-23.56).…”

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confidence: 97%

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Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

et al. 2022

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Introduction Isoniazid preventive therapy (IPT) can reduce the risk of tuberculosis (TB) in children living with HIV (CLHIV), but data on the outcomes of the IPT cascade in CLHIV are limited. Methods We evaluated the IPT cascade among CLHIV aged <15 years and newly enrolled in HIV care in eight HIV clinics in western Kenya. Medical record data were abstracted from September 2015 through July 2019. We assessed the proportion of CLHIV completing TB symptom screening, IPT eligibility assessment, IPT initiation and completion. TB incidence rate was calculated stratified by IPT initiation and completion status. Risk factors for IPT non‐initiation and non‐completion were assessed using Poisson regression with generalized linear models. Results Overall, 856 CLHIV were newly enrolled in HIV care, of whom 98% ([95% CI 97–99]; n = 841) underwent screening for TB symptoms and IPT eligibility. Of these, 13 (2%; 95% CI 1–3) were ineligible due to active TB and 828 (98%; 95% CI 97–99) were eligible. Five hundred and fifty‐nine (68%; 95% CI 64–71) of eligible CLHIV initiated IPT; median time to IPT initiation was 3.6 months (interquartile range [IQR] 0.5–10.2). Overall, 434 (78%; 95% CI 74–81) IPT initiators completed. Attending high‐volume HIV clinics (aRR = 2.82; 95% CI 1.20–6.62) was independently associated with IPT non‐initiation. IPT non‐initiation had a trend of being higher among those enrolled in the period 2017–2019 versus 2015–2016 (aRR = 1.91; 0.98–3.73) and those who were HIV virally non‐suppressed (aRR = 1.90; 95% CI 0.98–3.71). Being enrolled in 2017–2019 versus 2015–2016 (aRR = 1.40; 1.01–1.96) was independently associated with IPT non‐completion. By 24 months after IPT screening, TB incidence was four‐fold higher among eligible CLHIV who never initiated (8.1 per 1000 person years [PY]) compared to CLHIV who completed IPT (2.1 per 1000 PY; rate ratio [RR] = 3.85; 95% CI 1.08–17.15), with a similar trend among CLHIV who initiated but did not complete IPT (8.2/1000 PY; RR = 4.39; 95% CI 0.82–23.56). Conclusions Despite high screening for eligibility, timely IPT initiation and completion were suboptimal among eligible CLHIV in this programmatic cohort. Targeted programmatic interventions are needed to address these drop‐offs from the IPT cascade by ensuring timely IPT initiation after ruling out active TB and enhancing completion of the 6‐month course to reduce TB in CLHIV.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 97%

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confidence: 97%

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Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

et al. 2022

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“…Of several factors that contribute to the low uptake of TPT in the household contact groups, cost of travel to health facilities; perceived lack of need for TPT in children among parents; low level of knowledge among healthcare workers; stigma; other competing priorities of the family; and medication related challenges such as pill burden stand out as common barriers. 11 12 Other factors include fear of side effects, 7 lack of supplies and poor recording and reporting practices. 13 Common themes with the barriers include access and information, which may be better addressed with community-based interventions.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of women-led community interventions in improving tuberculosis preventive treatment in children: results from a comparative, before–after study in Ethiopia

Jerene

Assefa²,

Tesfaye³

et al. 2022

BMJ Open

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ObjectivesOur objective was to evaluate the impact of a service delivery model led by membership-based associations called Iddirs formed by women on tuberculosis preventive treatment (TPT) initiation and completion rates among children.DesignComparative, before-and-after study design.SettingThree intervention and two control districts in Ethiopia.ParticipantsChildren who had a history of close contact with adults with infectious forms of tuberculosis (TB). Child contacts in whom active TB and contraindications to TPT regimens were excluded were considered eligible for TPT.InterventionsBetween July 2020 and June 2021, trained women Iddir members visited households of index TB patients, screened child household contacts for TB, provided education and information on the benefits of TPT, linked them to the nearby health centre and followed them at home for TPT adherence and side effects. Two control zones received the standard of care, which comprised of facility-based provision of TPT to children. We analysed quarterly TPT data for treatment initiation and completion and compared intervention and control zones before and after the interventions and tested for statistical significance using Poisson regression.Primary and secondary outcome measuresThere were two primary outcome measures: proportion of eligible children initiated TPT and proportion completed treatment out of those eligible.ResultsTPT initiation rate among eligible under-15-year-old children (U15C) increased from 28.7% to 63.5% in the intervention zones, while it increased from 34.6% to 43.2% in the control zones, and the difference was statistically significant (p<0.001). TPT initiation rate for U5C increased from 13% (17 out of 131) to 93% (937 out of 1010). Of the U5C initiated, 99% completed treatment; two discontinued due to side effects; three parents refused to continue; and one child was lost to follow-up.ConclusionWomen-led Iddirs contributed to significant increase in TPT initiation and completion rates. The model of TPT delivery should be scaled-up.

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“…Although the proper implementation of international standards for TB prevention could prevent the deaths of thousands of children and adolescents around the globe [7], initiation and maintenance of preventive treatment is poor [8]. Various countries have reported non-compliance with policies aimed at medical management of TB contacts [9].…”

Section: Introductionmentioning

confidence: 99%

Management of Isoniazid Preventive Therapy in Southern Lima, Peru: An Analysis of Health Center Characteristics

Zegarra-Chapoñán¹,

Bonadonna

Yuen

et al. 2021

Preprint

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Background: Prevention of TB through the use of preventive treatment is a critical activity in the elimination of TB. Health personnel are a key element in achieving proper management of isoniazid preventive therapy (IPT) for TB contacts. This study aims to determine the association between health center characteristics and indicators of TB contact care management with isoniazid preventive therapy in southern Lima. Methods: We conducted an ecological study. Through the review of medical records, we identified children and adolescent contacts of tuberculosis patients, who initiated IPT between 2016 and 2018. We assessed bivariate associations between clinic staffing and IPT initiation and completion using binomial logistic regression with robust standard errors.Results: We included 977 contacts, among whom 69% took more than a week to start IPT and 41% did not complete IPT. For those who did successfully complete IPT, 58% were not medically evaluated with three follow-up appointments. While completion of IPT and 3 clinical appointments was better among health centers with more physicians and nurses, these differences were not statistically significant. Contact sex was associated with initiating IPT (p=0.005), and contact age was associated with completion of IPT (p=0.025) and completion of clinical evaluations (p=0.041). Conclusion: There are significant gaps in IPT management in health centers of southern Lima, Peru, but insufficient staffing of health centers may not be responsible. Further research is needed to identify how IPT management can be improved, including through improving training and staffing.

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Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review

Cited by 16 publications

References 31 publications

Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

Effectiveness of women-led community interventions in improving tuberculosis preventive treatment in children: results from a comparative, before–after study in Ethiopia

Management of Isoniazid Preventive Therapy in Southern Lima, Peru: An Analysis of Health Center Characteristics

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