Abstract
BackgroundThe World Health Organization recommends isoniazid preventive therapy (IPT) for six months for child contacts without tuberculosis (TB), who are exposed to an adult with active TB. The effectiveness of IPT depends on 80% or greater adherence to medication. In the current study, we assessed IPT adherence and explored barriers to and facilitators of adherence among eligible child contacts in Kigali, Rwanda.MethodsA mixed method study design was used to prospectively assess adherence to IPT among eligible child contacts and its associated factors through a quantitative, observational cohort study, and to explore barriers to and facilitators of adherence to IPT through a descriptive qualitative study.ResultsOf the 84 child contacts who started IPT, 74 (88%) had complete adherence and ten (12%) had incomplete adherence. There were no factors (individual characteristics of index cases, households and or health facility characteristics) found to be significantly associated with IPT adherence in the bivariate and multivariate analysis. In the qualitative analysis, we identified factors relating to parents/caregivers, disease, household and health-care providers as major themes determining IPT adherence.ConclusionThere was a high rate of IPT completion in this cohort of eligible child contacts living in Kigali. However, structural factors (poverty and relocation) were found to be the main barriers to IPT adherence that could be addressed by health-care providers.
Highlights
Young children exposed to an adult or older child with tuberculosis (TB), referred to as an index case [1], are at high risk of infection with Mycobacterium tuberculosis [2,3]
We identified factors relating to parents/caregivers, disease, household and health-care providers as major themes determining isoniazid preventive therapy (IPT) adherence
There was a high rate of IPT completion in this cohort of eligible child contacts living in Kigali
Summary
Young children exposed to an adult or older child with tuberculosis (TB), referred to as an index case [1], are at high risk of infection with Mycobacterium tuberculosis [2,3]. The World Health Organization (WHO) has for many years recommended isoniazid preventive therapy (IPT) for at least six months for young (
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