A Prospective Facility-Based Study in Alexandria, Egypt Aida Mohey Mohamed ,

1. Adherence to and Outcome of Isoniazid Preventive Chemotherapy in Household Children Contact with Adults Having Pulmonary Tuberculosis A Prospective Facility-Based Study in Alexandria, Egypt Aida Mohey Mohamed, Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt.

2. Problem statement Current international guidelines recommend 6–9 months of isoniazid (INH) preventive chemotherapy to prevent the development of active tuberculosis in children exposed to a susceptible strain of M. tuberculosis, but this treatment is dependent on good adherence Retrospective studies have indicated that adherence to unsupervised INH preventive chemotherapy is poor.

3. Objectives • to describe the outcome of screening in children ages <5 years with household exposure to an adult pulmonary tuberculosis index case • to determine the prevalence and possible risk factors of infection among children contacts • to determine the extent of adherence and outcome in children contacts to 6 months of unsupervised INH prophylaxis

4. METHODOLOGY • The child contacts were given unsupervised INH preventive chemotherapy once active tuberculosis was excluded. • Preventive chemotherapy consisted of unsupervised INH monotherapy for 6 months with monthly collection of tablets from the clinic. • Adherence to and outcome of preventive chemotherapy were prospectively monitored. • Adherence was considered reasonable if tablets were collected for more than 4 months, poor if collection occurred for 2–4 months, and very poor if monthly tablets are collected once or twice only (treatment period <2 months). Creating a Research Design • Setting: • Three of national TB control program chest dispensaries (primary care facilities) in Alexandria City, Egypt. • Subjects: • During a 3-month period, facility-based tuberculosis treatment registers were used to prospectively identify all new adult (>15 years) pulmonary tuberculosis cases. • All children <5 years old in household contact with index cases were identified and screened for tuberculosis. • N = 252 fully screened child • Interviewing format • Transfer sheet Establishing a Target Population A descriptive facility-based cross-sectional study Screening and treatment Tools Data Analysis • The data was entered, analyzed and tabulated using SPSS (version 18.0). • Frequencies were computed categorial variables. Proportions were compared simultaneouslyby the chi-squared test. Fisher exact test was used when the chi-squared-test was not valid. • Bivariate analysis of the risk factors for contracting a Latent TB infection was performed using the odds ratio and its 95% confidence interval. • A multivariate logistic regression model was constructed to control the confounders. The independent variables used in the logistic models were all dichotomous. • The level of significance was set at < 0.05.

5. Results 1: Tuberculosis screening results in children < 5 years old in household contact with an adult pulmonary tuberculosis index case

6. Results 2: Possible factors affecting risk of TB infection among children in household contact with adult patients

7. Results 3: Radiographic disease manifestations identified in child tuberculosis contacts (n = 252)

8. Results 4: Adherence to anti-tuberculosis treatment and preventive chemotherapy, and outcome according to preventive chemotherapy adherence (n = 252)

9. Results 5: Parent / Caregiver reported reasons for poor adherence of child contact (n=125) to INH preventive chemotherapy

10. Policy Implications & Conclusion • The prevalence of tuberculosis infection and clinical disease among children in household contact with adult patients is high, and risk is significantly increased due to child contact, index patients, and environmental factors. • Adherence to 6 months of unsupervised INH preventive chemotherapy was very poor. • Prevention and early detection of pediatric cases are essential tasks in TB control. • Findings of the present work confirm the importance of contact investigation in identifying new TB cases and providing chemoprophylaxis in young children based on the high risk of infection. • It emphasizes the need to develop chemoprophylaxis strategies with improved adherence, such as short duration multidrug supervised regimens, particularly in children who are at high risk of infection and disease progression following exposure.