ISONIAZID PREVENTIVE THERAPY COVERAGE AMONG CHILDREN AT HASAN SADIKIN GENERAL HOSPITAL
Stephanie Supriadi,Heda Melinda Nataprawira
Department of Child Health Universitas Padjadjaran
Background : Children living with adults suffering from pulmonary tuberculosis (TB) have higher risk of being infected. Isoniazid Preventive Therapy (IPT) administration is a crucial way to prevent the transmission. Eventhough IPT is part of WHO’s End TB strategy, it is not routinely given in Indonesia. Several challenges in our hospital are, e.g. unavailability of isoniazid (INH) as prophylaxis in Direct Observed Treatment Short-course (DOTS) clinic and unavailability of supporting examinations (Tuberculin Skin Test, or TST and Interferon Gamma Release Assays, or IGRA). The aim of this study is to describe the coverage of IPT in children at risk of being infected at Hasan Sadikin General Hospital.
Material : This cross-sectional study was conducted from January to April 2018 in our DOTS clinic. We obtained the database of bacteriologically-confirmed adult pulmonary TB as index cases. We contacted them by phone to look for children under 18 years old living together with index cases. Children under 5 years old without TB symptoms would be directly given IPT, while those aged 5?18 years old needed to undergo TST or IGRA first.We used the 4th generation IGRA (QuantiFERON-TB Gold Plus®). IPT administration was done when TST or IGRA was positive.
Results : There were 44 adult index cases obtained of whom 22 of 44 (50%) were successfully contacted by phone. Total children at risk from those were 28, with only 19 of 28 (68%) children attended the evaluation for IPT. Fifteen of 19 (79%) children were under 5 years and started IPT immediately and 4 of 19 (21%) between 5-18 years. IGRA tests were positive in 2 of 4 (50%).
Conclusions : In this study, only 50% of adult index cases could be contacted. The children from the rest of the adults were not recorded and protected by IPT. Those children were at risk of progressing into severe TB and becoming source of transmission. Promoting the importance and benefits of IPT in children in all health circles are mandatory.
Keywords: isoniazid preventive therapy tuberculosis children
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