Dartmouth College, Hanover, NH, 03755, USA.
, New York, USA.
BMC Infect Dis. 2020 Oct 7;20(1):738. doi: 10.1186/s12879-020-05471-z.
In accordance with international guidance for tuberculosis (TB) prevention, the Tanzanian Ministry of Health recommends isoniazid preventive therapy (IPT) for children aged 12 months and older who are living with HIV. Concerns about tolerability, adherence, and potential mistreatment of undiagnosed TB with monotherapy have limited uptake of IPT globally, especially among children, in whom diagnostic confirmation is challenging. We assessed IPT implementation and adherence at a pediatric HIV clinic in Tanzania.
In this prospective cohort study, eligible children living with HIV aged 1-15 years receiving care at the DarDar Pediatric Program in Dar es Salaam who screened negative for TB disease were offered a 6-month regimen of daily isoniazid. Patients could choose to receive IPT via facility- or community-based care. Parents/caregivers and children provided informed consent and verbal assent respectively. Isoniazid was dispensed with the child's antiretroviral therapy every 1-3 months. IPT adherence and treatment completion was determined by pill counts, appointment attendance, and self-report. Patients underwent TB symptom screening at every visit.
We enrolled 66 children between July and December 2017. No patients/caregivers declined IPT. Most participants were female (n = 43, 65.1%) and the median age was 11 years (interquartile range [IQR] 8, 13). 63 (95.5%) participants chose the facility-based model; due to the small number of participants who chose the community-based model, valid comparisons between the two groups could not be made. Forty-nine participants (74.2%) completed IPT within 10 months. Among the remaining 17, 11 had IPT discontinued by their provider due to adverse drug reactions, 5 lacked documentation of completion, and 1 had unknown outcomes due to missing paperwork. Of those who completed IPT, the average monthly adherence was 98.0%. None of the participants were diagnosed with TB while taking IPT or during a median of 4 months of follow-up.
High adherence and treatment completion rates can be achieved when IPT is integrated into routine, self-selected facility-based pediatric HIV care. Improved record-keeping may yield even higher completion rates. IPT was well tolerated and no cases of TB were detected. IPT for children living with HIV is feasible and should be implemented throughout Tanzania.
根据国际结核病（TB）防治指南，坦桑尼亚卫生部建议对 12 个月及以上、与 HIV 共患的儿童进行异烟肼预防治疗（IPT）。由于对单药治疗潜在的不耐受、不依从和对未确诊的 TB 的潜在滥用的担忧，IPT 在全球范围内，尤其是在诊断确认具有挑战性的儿童中，接受率有限。我们评估了坦桑尼亚一家儿科 HIV 诊所的 IPT 实施和依从情况。
在这项前瞻性队列研究中，在达累斯萨拉姆的达达尔儿科项目接受治疗、筛查出无结核病的、年龄在 1 至 15 岁的 HIV 共患儿童，如果符合条件，将接受为期 6 个月的每日异烟肼治疗。患者可以选择通过机构或社区为基础的护理来接受 IPT。家长/照顾者和儿童分别提供知情同意和口头同意。异烟肼与儿童的抗逆转录病毒治疗一起每 1-3 个月分发一次。IPT 依从性和治疗完成情况通过药片计数、预约出席和自我报告来确定。患者每次就诊时都接受 TB 症状筛查。
我们于 2017 年 7 月至 12 月期间纳入了 66 名儿童。没有患者/照顾者拒绝接受 IPT。大多数参与者为女性（n=43，65.1%），中位年龄为 11 岁（四分位距 [IQR] 8，13）。63 名（95.5%）参与者选择了机构为基础的模式；由于选择社区为基础模式的参与者人数较少，因此无法对两组进行有效比较。49 名参与者（74.2%）在 10 个月内完成了 IPT。在其余的 17 名参与者中，由于药物不良反应，11 名参与者的 IPT 被其提供者中断，5 名参与者缺乏完成IPT 的记录，1 名参与者由于文书工作丢失而未知结局。在完成 IPT 的参与者中，平均每月的依从率为 98.0%。在服用 IPT 期间或中位 4 个月的随访期间，没有参与者被诊断患有 TB。
当 IPT 被整合到常规、自我选择的机构为基础的儿科 HIV 护理中时，可以实现高依从性和治疗完成率。改善记录保存可能会产生更高的完成率。IPT 耐受性良好，未发现 TB 病例。IPT 适用于 HIV 共患儿童，应在坦桑尼亚全国范围内实施。
