Gaps in the tuberculosis preventive therapy care cascade in children in contact with TB.

IF 1.4 4区医学 Q3 PEDIATRICS

Paediatrics and International Child Health Pub Date : 2021-11-01 Epub Date: 2021-09-17 DOI:10.1080/20469047.2021.1971360

E Van Ginderdeuren, J Bassett, C F Hanrahan, L Mutunga, A Van Rie

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引用次数: 3

Abstract

Background: Young children (<5 years) and children living with HIV in contact with an adult with tuberculosis (TB) should receive TB preventive therapy (TPT), but uptake is low.

Aims: To determine gaps in the uptake of and adherence to TPT in child TB contacts under routine primary care clinic conditions.

Methods: A cohort of child TB contacts (age <5 years or living with HIV <15 years) was followed at a primary care clinic in Johannesburg, South Africa.

Results: Of 170 child contacts with 119 adult TB cases, only 45% (77/170) visited the clinic for TPT eligibility screening, two of whom had already initiated TPT at another clinic. Of the 75 other children, 18/75 (24%) commenced TB treatment and 56/75 (75%) started TPT. Health-care workers followed the guidelines, with 96% (64/67) of children screened for symptoms of TB and 97% (36/37) of those symptomatic assessed for TB, but microbiological testing was low (9/36, 25%) and none had microbiologically confirmed tuberculosis. Only half (24/46, 52%) of the children initiating TPT completed the 6-month course. Neither sociodemographic determinants (age, sex) nor clinical factors (HIV status, TB source, time to TPT initiation) was associated with non-adherence to TPT.

Conclusion: Most child contacts of an adult TB case do not visit the clinic, and half of those initiating TPT did not adhere to the full 6-month course. These programme failures result in missed opportunities for early diagnosis of active TB and prevention of progression to disease in young and vulnerable children.

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接触结核病的儿童在结核病预防治疗护理级联中的差距。

背景:幼儿(目的:确定常规初级保健临床条件下接触结核的儿童在接受和坚持TPT方面的差距。结果:在170名儿童接触者和119名成人结核病病例中，只有45%(77/170)到诊所进行了TPT资格筛查，其中两人已经在另一家诊所开始了TPT。在其他75名儿童中，18/75(24%)开始结核病治疗，56/75(75%)开始TPT治疗。卫生保健工作者遵循了该指南，96%(64/67)的儿童接受了结核病症状筛查，97%(36/37)的有症状的儿童接受了结核病评估，但微生物检测水平很低(9/ 36,25 %)，而且没有人得到微生物确诊。在接受TPT治疗的儿童中，只有一半(24/ 46,52%)完成了6个月的疗程。社会人口统计学决定因素(年龄、性别)和临床因素(艾滋病毒感染状况、结核病来源、开始TPT治疗的时间)都与不坚持TPT治疗无关。结论:成人结核病例的大多数儿童接触者不去诊所，半数开始TPT治疗的儿童没有坚持完整的6个月疗程。这些规划的失败导致错过了早期诊断活动性结核病和预防年幼和脆弱儿童疾病进展的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Paediatrics and International Child Health PEDIATRICS-

CiteScore

3.30

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Paediatrics and International Child Health is an international forum for all aspects of paediatrics and child health in developing and low-income countries. The international, peer-reviewed papers cover a wide range of diseases in childhood and examine the social and cultural settings in which they occur. Although the main aim is to enable authors in developing and low-income countries to publish internationally, it also accepts relevant papers from industrialised countries. The journal is a key publication for all with an interest in paediatric health in low-resource settings.