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Isoniazid preventive treatment in children in two districts of South India: does practice follow policy?

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SETTING: Two districts of Tamil Nadu, India

OBJECTIVES: To determine the proportion of household contacts aged <6 years of patients with tuberculosis (TB) with positive sputum microscopy results who initiated and completed isoniazid preventive treatment (IPT), and to determine reasons for non-initiation and non-completion of IPT.

DESIGN: Household visits were conducted on a random sample of adult patients registered during January–June 2012 to identify household contacts aged <6 years.

RESULTS: Among 271 children living with 691 index patients, 218 (80%) were evaluated and 9 (4%) were diagnosed with TB. Of 209 remaining contacts, 70 (33%) started IPT and 16 (22.9%) completed a full course of IPT. Of 139 contacts who did not start IPT, five developed TB disease. Reasons for non-initiation of IPT included no home visit by the field staff (19%) and no education about IPT (61%). Reasons for non-completion included isoniazid not provided (52%) and long duration of treatment (28%).

CONCLUSION: This study shows that Revised National TB Programme guidance was not being followed and IPT implementation was poor. Poor IPT uptake represents a missed opportunity to prevent future TB cases. Provision of IPT may be improved through training, improved logistics and enhanced supervision and monitoring.
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Keywords: children; contact investigation; isoniazid; preventive treatment; tuberculosis

Document Type: Research Article

Affiliations: 1: World Health Organization Country Office in India, New Delhi 2: Revised National TB Control Programme (RNTCP) District Tuberculosis Unit, Krishnagiri and Dharmapuri Districts, Tamilnadu 3: RNTCP State Tuberculosis Unit, Tamilnadu 4: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India 5: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: August 1, 2014

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