Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions
Young children living with a tuberculosis patient are at high risk of Mycobacterium tuberculosis infection and disease. WHO guidelines promote active screening and isoniazid (INH) preventive therapy (PT) for such children under 5 years, yet this well‐established intervention is seldom used in endemic countries. We review the literature regarding barriers to implementation of PT and find that they are multifactorial, including difficulties in screening, poor adherence, fear of increasing INH resistance and poor acceptability among primary caregivers and healthcare workers. These barriers are largely resolvable, and proposed solutions such as the adoption of symptom‐based screening and shorter drug regimens are discussed. Integrated multicomponent and site‐specific solutions need to be developed and evaluated within a public health framework to overcome the policy–practice gap and provide functional PT programmes for children in endemic settings.
Document Type: Research Article
Affiliations: 1: Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand 2: Department of Pediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia 3: Mersey Deanery, Liverpool, UK 4: Department of Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands 5: Centre for International Child Health, University of Melbourne, Department of Paediatrics and Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Vic., Australia
Publication date: October 1, 2012