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

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.