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Infants and children are dependent on caregivers to administer medicines. Barriers faced by adult caregivers can contribute to children missing doses. Considerations for adherence in adolescents are covered in Section 7.4.
Potential barriers for children include the following:
Adherence to any course of treatment is a complex behaviour influenced by many factors, such as personal motivation, beliefs about health, perceived risks and benefits of treatment, comorbidities, competing demands that conflict with taking medicines, the family environment, complexity of the treatment regimen, toxicity of medicines, and trust and relationship with providers. Effective person-centred strategies to promote adherence to TPT may include the following (15):
Children and adolescents on TPT should be reviewed every month for those on a 3-month regimen (e.g. 3HR or 3HP), or every 2 months for those on a 6-month regimen (e.g. 6H) or DR-TB TPT, ideally at a health care facility or by treatment supporters (see Section 6.4) or by using digital tools such as video-supported treatment (69).
Household contacts of people with MDR-TB or isoniazid monoresistance are at higher risk of TB infection than contacts exposed to people with drug-susceptible TB. The risk of progression to TB disease does not differ among contacts in either group (67). Studies have reported approximately 90% reduction in MDR-TB incidence with TPT after known exposure (68). WHO recommends using TPT for contacts exposed to people with MDR-TB following consideration of the intensity of exposure, confirming the source patient and their drug resistance pattern (i.e.
The WHO task force on pharmacokinetics and pharmacodynamics analysed available evidence from clinical trials of rifapentine and suggested a simplified dose for various weight bands for 3HP and 1HP for the 2020 WHO consolidated guidelines on tuberculosis. Module 1: prevention – tuberculosis preventive treatment (28). Table 3.2 presents standard dosing for the recommended TPT regimens by age and body weight.
The choice of TPT regimen depends on the age of the child, the HIV and ART status, and the availability and affordability of suitable (child-friendly) formulations.14 Rifampicin- and rifapentine-containing regimens should be prescribed with caution in children and adolescents living with HIV and on ART because of potential drug–drug interactions (see Section 7.1 and Tables 7.2 and 7.3). Table 3.1 summarizes the options for different target and age g
The following options for TPT are recommended by WHO for use in children and adolescents:
1 month of daily isoniazid plus rifapentine (1HP) (aged 13 years and over) or 4 months of daily rifampicin (4R) (all ages) may be offered as alternative regimens.
IGRA is a whole-blood test that can help to diagnose M. tuberculosis infection. Like TST, it does not differentiate between TB infection and TB disease. IGRA measures the cell-mediated immune response of people with TB infection. T-cells of infected people are sensitized to TB and respond to stimulation with peptides simulating those expressed by TB bacteria by secreting a cytokine called interferon-gamma. IGRA uses peptides from proteins made almost exclusively by M. tuberculosis and other mycobacteria from the M. tuberculosis complex.
TST is a method to detect TB infection that involves intradermal injection of tuberculin purified protein derivative (PPD). Previous exposure results in a local delayed-type hypersensitivity reaction within 24–72 hours (6). The reaction is identified as palpable induration at the site of injection. It only indicates hypersensitivity to proteins of the TB bacillus as a result of infection with M. tuberculosis or induced by BCG vaccination. A positive TST does not indicate the presence or extent of TB disease.
TST or IGRA can be used to test for TB infection. People living with HIV who are on ART (including adolescents and children) benefit from TPT regardless of whether they test positive or negative for TB infection. People living with HIV who are not on ART and who test positive for TB infection are shown to benefit more from TPT than those who test negative (49).