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.

中文翻译：

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与结核病接触的儿童的结核病预防性治疗护理级联差距

摘要

背景

幼儿（<5 岁）和与患有结核病 (TB) 的成人接触的 HIV 感染儿童应接受结核病预防治疗 (TPT)，但吸收率较低。

目标

确定在常规初级保健诊所条件下儿童结核病接触者在接受和坚持 TPT 方面的差距。

方法

在南非约翰内斯堡的一家初级保健诊所跟踪了一组儿童结核病接触者（年龄 <5 岁或感染 HIV <15 岁）。

结果

在与 119 名成人 TB 病例的 170 名儿童接触者中，只有 45% (77/170) 到诊所进行 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。卫生保健工作者遵循指南，96% (64/67) 的儿童接受了结核病症状筛查，97% (36/37) 有症状的儿童接受了结核病评估，但微生物检测偏低（9/36, 25% ) 并且没有人有微生物学证实的结核病。只有一半 (24/46, 52%) 发起 TPT 的儿童完成了 6 个月的课程。社会人口学决定因素（年龄、性别）和临床因素（艾滋病毒状况、结核病源、开始 TPT 的时间）都与不遵守 TPT 相关。

结论

大多数成人结核病病例的儿童接触者不去诊所，而启动 TPT 的人中有一半没有坚持完整的 6 个月疗程。这些计划的失败导致错过了早期诊断活动性结核病和预防幼儿和弱势儿童疾病进展的机会。