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Open Access Isoniazid preventive treatment among child contacts of adults with smear-positive tuberculosis in The Gambia

Setting: Greater Banjul area of The Gambia.

Objectives: To evaluate uptake, adherence and completion of treatment among tuberculosis (TB) exposed children in The Gambia when isoniazid preventive treatment (IPT) is delivered at home

Design: Child (age <5 years) contacts of adults with smear-positive TB were prospectively enrolled. Following symptom screening, tuberculin skin testing and clinical evaluation where indicated, those without disease were placed on daily isoniazid, provided monthly at home. Adherence was assessed by pill counts and IsoScreen urine test.

Results: Of 404 contacts aged <5 years, 368 (91.1%) were offered IPT. Of the 328 (89.4%) for whom consent was received and who commenced IPT, 18 (5.5%) dropped out and 310 (94.5%) remained on IPT to the end of the 6-month regimen. Altogether, 255/328 children (77.7%, 95%CI 73.2–82.2) completed all 6 months, with good adherence. The IsoScreen test was positive in 85.3% (435/510) of all tests among those defined as having good adherence by pill count and in 16% (8/50) of those defined as having poor adherence (P < 0.001). A cascade of care analysis showed an overall completion rate with good adherence of 61% for all child contacts.

Conclusion: Home-delivered IPT among child contacts of adults with smear-positive TB in The Gambia achieved verifiable high uptake and adherence rates. System rather than patient factors are likely to determine the success of IPT at national level.

Keywords: IPT; IsoScreen; adherence; cascade of care; prophylaxis

Document Type: Research Article

Affiliations: 1: Vaccines and Immunity Theme, Medical Research Council Unit–The Gambia, Banjul, The Gambia 2: Vaccines and Immunity Theme, Medical Research Council Unit–The Gambia, Banjul, The Gambia, Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada 3: National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia 4: Centre for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany 5: Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand 6: Vaccines and Immunity Theme, Medical Research Council Unit–The Gambia, Banjul, The Gambia, Centre for International Child Health, Academic Department of Paediatrics, Imperial College London, London, UK

Publication date: December 21, 2016

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