Tuberculosis contact investigation and short-course preventive therapy among young children in Africa
OBJECTIVE: To demonstrate the feasibility and document the effectiveness of household contact investigation and preventive therapy in resource-limited settings.
DESIGN: Children under 5 years living at home with adults with bacteriologically confirmed pulmonary tuberculosis (TB) were screened using questionnaire, clinical examination, tuberculin skin test and chest X-ray. Children free of active TB were offered preventive treatment with a 3-month rifampicin-isoniazid (3RH) or 6-month isoniazid (6H) regimen in Benin. Children were followed-up monthly during treatment, then quarterly over 1 year. Costs of transportation, phone contacts and chest X-rays were covered.
RESULTS: A total of 1965 children were enrolled, of whom 56 (2.8%) had prevalent TB at inclusion. Among the 1909 children free of TB, 1745 (91%) started preventive therapy, 1642 (94%) of whom completed treatment. Mild adverse reactions, mostly gastrointestinal, were reported in 2% of children. One case of incident TB, possibly due to a late TB infection, was reported after completing the 3RH regimen.
CONCLUSION: Contact investigation and preventive therapy were successfully implemented in these resource-limited urban settings in programmatic conditions with few additional resources. The 3RH regimen is a valuable alternative to 6H for preventing TB.
Keywords: TB prevalence; child; isoniazid; latent TB; rifampicin
Document Type: Research Article
Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Paris 2: International Union Against Tuberculosis and Lung Disease, Paris, école Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou 3: National Tuberculosis Program, Cotonou, Benin 4: National Tuberculosis Program, Ouagadougou, Burkina Faso 5: National Tuberculosis Program, Yaoundé, Cameroon 6: Complexe pédiatrique, Bangui, Central African Republic 7: Centre Hospitalier Universitaire Necker-Enfants Malades, Paris, France 8: United Nations Childrens' Fund, New York, NY, USA 9: International Union Against Tuberculosis and Lung Disease, Paris, University of Melbourne and Burnet Institute, Melbourne, Australia 10: Département de Santé publique, Canton de Vaud, Lausanne, Switzerland 11: UMI TransVIHMI, Institut de Recherche pour le Développement, Montpellier, France
Publication date: 01 April 2020
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