Background
Children and adolescents with household exposure to multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) are at high-risk of developing TB disease. Tuberculosis preventive therapy (TPT) is recommended, but programmatic experience is limited, particularly for adolescents.
Methods
We conducted a prospective cohort study to describe MDR/RR-TB diagnosis and TPT provision for individuals aged <18years with MDR/RR-TB exposure. Participants were assessed for TB either in homes or health facilities, with referral for chest X-ray or specimen collection at clinician discretion. TPT regimens included levofloxacin, isoniazid or delamanid monotherapy for 6-months, based on source patient drug-resistance profile.
Results
Between March 1, 2020 and July 31, 2021, 112 participants were enrolled; median age 8.5 years, 57 (51%) female and 6 (5%) living with HIV. On screening, 11 (10%) were diagnosed with TB; 10 presumptive MDR/RR-TB and 1 drug-susceptible TB. Overall, 95 (94% of 101) participants started TPT: 79 with levofloxacin, 9 isoniazid and 7 delamanid. 76 (80%) completed TPT, 12 (13%) were lost to follow-up and 7 (7%) stopped TPT early due to adverse events. Potential adverse events were reported for 12 (13%) participants; none were serious. There were no further TB diagnoses (200 days median follow-up).
Conclusions
Post MDR/RR-TB exposure management for children and adolescents resulted in significant MDR/RR-TB detection and both high TPT initiation and completion. TPT monotherapy was well tolerated and there were no further TB diagnoses after initial assessment. Key factors supporting these outcomes included use of paediatric formulations for young children, monotherapy and community-based options for assessment and follow-up.