Does an Isoniazid Prophylaxis Register Improve Tuberculosis Contact Management in South African Children?

Nelda Van Soelen,Karen Du Preez,Anthony J Reid,Susan S Van Wyk,Anna M Mandalakas,Anneke C Hesseling,Don A Enarson

doi:10.1371/journal.pone.0080803

Abstract

SettingWe compared the change in child household contact management of pulmonary tuberculosis (TB) cases before and after the implementation of an isoniazid preventive therapy (IPT) register in an urban clinic setting in Cape Town, South Africa.ObjectivesWe determined if the presence of an IPT register was associated with an increase in the number of child contacts identified per infectious case and the proportion of identified children who were started on IPT.DesignWe reviewed routine programme data on IPT delivery to children during two time periods (May 2008–October 2008 and May 2011–October 2011), before and after the implementation of an IPT register used by routine clinic personnel.ResultsAdult TB case demographic and clinical characteristics from the two observation periods were similar. During the post-register period, more child contacts per adult case were identified (0.7 (54 children) vs. 0.3 (24 children)), more of the identified children were started on IPT (54 vs. 4) and 37% of those who started, completed six months of treatment compared to the pre-register period where no adherence information was recorded.ConclusionsAfter pilot implementation of an IPT register, documented identification of child contacts, IPT initiation and IPT adherence documentation in TB exposed children was improved. Our findings support further exploration of the potential impact of using standardised IPT recording and reporting in routine clinics in high-burden TB settings to improve TB prevention efforts targeted at young children. Future efforts to improve IPT delivery should be systematic and comprehensive in order to support a change in current operational IPT delivery practices in TB programs.

Highlights

Children constituted an estimated 6% (490 000) of the total number of tuberculosis (TB) incident cases globally in 2011 against a background of considerable under-reporting of TB in children [1]
Our findings support further exploration of the potential impact of using standardised Isoniazid preventive therapy (IPT) recording and reporting in routine clinics in high-burden TB settings to improve TB prevention efforts targeted at young children
Future efforts to improve IPT delivery should be systematic and comprehensive in order to support a change in current operational IPT delivery practices in TB programs

Summary

Introduction

Children constituted an estimated 6% (490 000) of the total number of tuberculosis (TB) incident cases globally in 2011 against a background of considerable under-reporting of TB in children [1]. In line with the evidence of the benefits of IPT, the South African National TB Programme (SANTP) guidelines, consistent with the World Health Organization (WHO), recommend that all children under five years of age [4] and all HIV-infected children, regardless of age, receive IPT if they are exposed to a household adult with bacteriologically confirmed TB (sputum smear- and/or culture positive pulmonary TB), once active TB disease is excluded [5] Despite these official prevention guidelines, previous studies from Cape Town South Africa [6,7] and other high-burden settings [8,9,10], have illustrated the challenges of documenting contacts in routine clinical records and indicated that only a low proportion of eligible identified contacts received IPT in these high-burden settings

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Discussion

Conclusion