Uptake of Isoniazid Preventive Therapy among Under-Five Children: TB Contact Investigation as an Entry Point

• Published in: PloS one 2016-05, Vol.11 (5), p.e0155525-e0155525
• Main Authors: Tadesse, Yared, Gebre, Nigussie, Daba, Shallo, Gashu, Zewdu, Habte, Dereje, Hiruy, Nebiyu, Negash, Solomon, Melkieneh, Kassahun, Jerene, Degu, K Haile, Yared, Kassie, Yewulsew, Melese, Muluken, G Suarez, Pedro
• Format: Article
• Language: English
• Subjects: Age; Algorithms; Analysis; Antitubercular Agents - therapeutic use; Chief executive officers; Child, Preschool; Children; Children & youth; Communicable Disease Control; Confidence intervals; Contact Tracing; Data Collection; Data processing; Development and progression; Disease; Disease prevention; Ethiopia; Health care facilities; Humans; Infant; Investigations; Isoniazid; Isoniazid - therapeutic use; Medical screening; Medicine and Health Sciences; People and Places; Performance evaluation; Prevention; Preventive medicine; Public health; Risk; Smear; Therapy; Tuberculosis; Tuberculosis - prevention & control; Tuberculosis - transmission; Tuberculosis, Pulmonary - diagnosis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0155525

A child's risk of developing tuberculosis (TB) can be reduced by nearly 60% with administration of 6 months course of isoniazid preventive therapy (IPT). However, uptake of IPT by national TB programs is low, and IPT delivery is a challenge in many resource-limited high TB-burden settings. Routinely collected program data was analyzed to determine the coverage and outcome of implementation of IPT for eligible under-five year old children in 28 health facilities in two regions of Ethiopia. A total of 504 index smear-positive pulmonary TB (SS+) cases were reported between October 2013 and June 2014 in the 28 health facilities. There were 282 under-five children registered as household contacts of these SS+ TB index cases, accounting for 17.9% of all household contacts. Of these, 237 (84%) were screened for TB symptoms, and presumptive TB was identified in 16 (6.8%) children. TB was confirmed in 5 children, producing an overall yield of 2.11% (95% confidence interval, 0.76-4.08%). Of 221 children eligible for IPT, 64.3% (142) received IPT, 80.3% (114) of whom successfully completed six months of therapy. No child developed active TB while on IPT. Contact screening is a good entry point for delivery of IPT to at risk children and should be routine practice as recommended by the WHO despite the implementation challenges.