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Free Content Determinants of tuberculosis treatment completion among newborns in a high-burden setting

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BACKGROUND: Newborns exposed to Mycobacterium tuberculosis are at high risk of progression to tuberculosis (TB) disease.

DESIGN AND SETTING: A prospective cohort study conducted in Cape Town, South Africa, from January 2011 to June 2012. TB-exposed newborns requiring isoniazid preventive therapy (IPT) or anti-tuberculosis treatment were followed to 6 months of age. Appropriate tuberculosis treatment referral, maternal and socio-economic determinants were evaluated. The primary outcome, completion of treatment (6 months IPT, 3 months IPT with a negative tuberculin skin test, or 6 months' treatment for disease) was measured at 6 months. Data were collected from folders and care giver interviews. Cox regression was used to determine hazard ratios (HR) for non-completion of treatment.

RESULTS: Fifty-six (63% human immunodeficiency virus [HIV] exposed) TB-exposed newborns were included; median gestational age and mean birth weight were respectively 36 weeks and 2242 g. Of the 56 newborns, 44 (79%) were followed to 6 months; 29/44 (66%) completed anti-tuberculosis treatment without study team intervention. Appropriate treatment referral was associated with a lower hazard of non-completion of treatment (unadjusted HR 0.34, 95%CI 0.12–0.93). This relationship was maintained in multivariable adjustment for maternal HIV status and type of care giver (adjusted HR 0.26, 95%CI 0.09–0.77).

CONCLUSIONS: Appropriate anti-tuberculosis treatment referral improves completion of treatment in infants.
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Keywords: HIV; IPT; exposure; maternal

Document Type: Research Article

Affiliations: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Publication date: March 1, 2014

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

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