Abstract
BackgroundIt is recommended that young child contacts of sputum smear positive tuberculosis cases receive isoniazid preventive therapy (IPT) but reported adherence is low and risk factors for poor adherence in children are largely unknown.MethodsWe prospectively determined rates of IPT adherence in children < 5 yrs in an Indonesian lung clinic. Possible risk factors for poor adherence, defined as ≤3 months prescription collection, were calculated using logistic regression. To further investigate adherence barriers in-depth interviews were conducted with caregivers of children with good and poor adherence.ResultsEighty-two children eligible for IPT were included, 61 (74.4%) of which had poor adherence. High transport costs (OR 3.3, 95% CI 1.1-10.2) and medication costs (OR 20.0, 95% CI 2.7-414.5) were significantly associated with poor adherence in univariate analysis. Access, medication barriers, disease and health service experience and caregiver TB and IPT knowledge and beliefs were found to be important determinants of adherence in qualitative analysis.ConclusionAdherence to IPT in this setting in Indonesia is extremely low and may result from a combination of financial, knowledge, health service and medication related barriers. Successful reduction of childhood TB urgently requires evidence-based interventions that address poor adherence to IPT.
Highlights
It is recommended that young child contacts of sputum smear positive tuberculosis cases receive isoniazid preventive therapy (IPT) but reported adherence is low and risk factors for poor adherence in children are largely unknown
Indonesia is among the high burden countries [13] that support active contact tracing and IPT as part of their national TB program. In this setting such action has great potential; a recent study from West Java found 51% of actively screened children aged < 9 yrs living with a sputum smear positive case were positive for TB infection.(Rutherford et al In press) Yet IPT is rarely implemented and current services are centralised to hospitals and specialised clinics
We prospectively assessed adherence rates and risk factors for poor adherence to IPT in a cohort of actively screened Indonesian children < 5 yrs living with a sputum smear positive adult TB case. Setting and participants This sub-study was conducted between April 2009 and September 2010 as part of a larger investigation evaluating tools for the diagnosis of latent tuberculosis infection (LTBI).(Rutherford et al In press) Recruitment was conducted at a community lung clinic in Bandung, Indonesia where all newly diagnosed sputum smear and chest x-ray (CXR) positive adult TB patients (≥15 yrs) with one or more child contacts were invited to bring their children to the clinic to undergo screening
Summary
It is recommended that young child contacts of sputum smear positive tuberculosis cases receive isoniazid preventive therapy (IPT) but reported adherence is low and risk factors for poor adherence in children are largely unknown. IPT is safe and effective; side effects in children are extremely rare [6,7,8] and efficacy is over 90% when taken correctly [9] This recommendation is rarely put in to Indonesia is among the high burden countries [13] that support active contact tracing and IPT as part of their national TB program. In this setting such action has great potential; a recent study from West Java found 51% of actively screened children aged < 9 yrs living with a sputum smear positive case were positive for TB infection.(Rutherford et al In press) Yet IPT is rarely implemented and current services are centralised to hospitals and specialised clinics. No data are available on adherence levels or associated barriers, with respect to IPT for child case contacts in Indonesia
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