Operational challenges in managing Isoniazid Preventive Therapy in child contacts: A high-burden setting perspective

Abstract

BackgroundThe study was conducted at a high TB-HIV burden primary health community clinic in Cape Town, South Africa. We describe the management of children under five years of age in household contact with a smear and/or culture-positive adult TB case.MethodsThis study was a record review of routinely-collected programme data.ResultsA total of 1094 adult TB case folders were reviewed. From all identified contacts, 149 children should have received IPT based on local guidelines; in only 2/149 IPT was initiated. Management of child contacts of sputum smear and/or culture-positive compared to sputum-negative TB patients were similar.ConclusionsIPT delivery to children remains an operational challenge, especially in high TB-HIV burden communities. A tool to improve IPT management and targeting sputum smear and/or culture-positive TB child contacts may overcome some of these challenges and should be developed and piloted in such settings.

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

“…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. 33 As in other countries, we found that primary caregivers' acceptance of the child contact management programme was hindered by barriers such as limited knowledge of isoniazid preventive therapy, difficulty accessing screening and treatment and reluctance to treat asymptomatic children.…”

“…5,8 In South Africa and Thailand, reported rates were under 3% and 52%, respectively. 22,23 In contrast, the compliance rate in India for symptom-based screening conducted at the child's home was 67%. 24 Screening conducted in children's homes using symptom-based screening, which is recommended by WHO, 4 would be expected to improve the performance of child contact management systems.…”

Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia

“…17 Going a step further, efforts to reduce TB in the adult population, and aggressively reduce transmission by means of contact tracing and prophylaxis could also lead to a reduction in childhood TB. Transmission reduction is notoriously challenging, 18 but has proved cost-effective in high-burden settings. 19 HIV coinfection was associated with increased risk of death during anti-tuberculosis treatment, as has been reported elsewhere.…”

How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa

“…[1,9,10] It focuses on the functioning of health systems [ 3,[11][12][13] and on the operational aspects of clinical care. [14][15][16][17][18][19] While the National Department of Health is committed to improving access to medicine, the procurement and distribution of medical supplies remains inadequate in many health districts. [20] Research on stock-outs has strived to quantify the extent and severity of shortages of medical supplies.…”