Implementing a tuberculosis child contact register to quantify children at risk for tuberculosis and HIV in Eldoret, Kenya

Abstract

Implementation of a CCR is a possible first step in child contact identification and management, which requires minimal resources and identifies children at risk for TB and HIV. Child contact screening and IPT initiation remain a challenge, and additional strategies are urgently needed.

Challenges to delivery of isoniazid preventive therapy in a cohort of children exposed to tuberculosis in Timor‐Leste

“…In realising the secondary aim of this study to determine the number of children screened and provided with IPT, our limited experience shows that a low percentage of children (26%) attended screening after verbal and written advice, although this is higher than that reported in some cohorts in Sub Saharan Africa , India and Indonesia . The high attrition rate of children who are referred for further tests or antibiotics following initial IPT screening (16%) is concerning, particularly as a proportion of these children requiring further investigation may have active TB.…”

“…In a Thai qualitative study [19], one of the reasons cited for not bringing contacts for screening was that the contact was not the index case's own child and therefore they could not bring them, suggesting that the observed association between index case not being the parent and non-attendance for screening may not be unique to Timor-Leste. In realising the secondary aim of this study to determine the number of children screened and provided with IPT, our limited experience shows that a low percentage of children (26%) attended screening after verbal and written advice, although this is higher than that reported in some cohorts in Sub Saharan Africa [13,20,21], India [22] and Indonesia [23]. The high attrition rate of children who are referred for further tests or antibiotics following initial IPT screening (16%) is concerning, particularly as a proportion of these children requiring further investigation may have active TB.…”

“…The barriers to IPT screening from the patient and carer perspective are not understood in the Timorese setting but difficulty accessing services (with cost a major factor), large household size, poor primary caregiver acceptability of IPT, low-risk perception of TB disease, treatment duration, influence of friends, lack of knowledge regarding IPT and TB and family problems have all been cited as significant factors in other settings [2,3,16,19,20,22,26]. It is unclear what the external validity of these studies' findings are to Timor-Leste.…”

Childhood tuberculosis: no longer an orphan disease? [Editorial]

“…4 What has been lacking, however, is operational research exploring the barriers to TB diagnosis, treatment and prevention among children. It is heartening to see this edition of Public Health Action dedicated to the topic, [5][6][7][8][9] and it is hoped that this will inspire others in this important fi eld of research.There are many areas that need urgent attention. These include the development and implementation of point-of-care diagnostics for children, new childfriendly drugs for children with drug-susceptible and drug-resistant tuberculosis, randomised controlled clinical trials to ensure optimal treatment for complicated cases such as TB meningitis, new short-course interventions to prevent TB and a new, effective vaccine.…”

“…4 What has been lacking, however, is operational research exploring the barriers to TB diagnosis, treatment and prevention among children. It is heartening to see this edition of Public Health Action dedicated to the topic, [5][6][7][8][9] and it is hoped that this will inspire others in this important fi eld of research.…”