Correlates of Tuberculosis preventive therapy uptake among under-five contacts of adults with bacteriologically confirmed Tuberculosis in Mubende District

Abstract

Background: Tuberculosis (TB) remains a leading or major cause of ill health and mortality in many countries globally. Globally, in 2020, TB was the 13th leading cause of death and second leading infectious killer after COVID-19 with an estimated 1.1 million children infected. Infants and children under five years exposed to a smear positive pulmonary tuberculosis patient are at a high risk of infection and progression to TB disease. Healthcare interventions for prevention of TB among children are vaccination with BCG, prevention of transmission of M. Tuberculosis through infection prevention and control and treatment of children with latent Tuberculosis infection (LTBI) with TB preventive therapy (TPT). Tuberculosis preventive therapy (TPT) reduces the risk of TB disease by 60% in children exposed to adults with TB. In Uganda, only 34% of children under five who were household contacts of adults with bacteriologically confirmed tuberculosis were on TPT according to WHO estimates in 2020. The study aimed to assess the factors influencing TB preventive therapy uptake among eligible under-five contacts of adults with bacteriologically confirmed tuberculosis in Mubende district. Methods: A cross sectional study among children under-five years in Mubende district eligible for TPT based on Uganda TB control guidelines. Data was abstracted from unit TB registers for new or recurrent patients aged fifteen years or older with bacteriologically confirmed tuberculosis (TB) that were diagnosed in the period October 2018 to September 2020. A structured questionnaire was administered after obtaining informed consent of the index case and from parents, caretakers or guardians of the under-five contact; assent from index cases aged 15 – 17 years. The data collected was entered in Epidata V3.1 and exported to STATA V14 for analysis. Bivariate and multivariate analysis using logistic regression models was utilized to determine the influencers of uptake of Tuberculosis preventive therapy (TPT). A p-value < 0.05 was considered significant. Results: Of the 260 under-five children enrolled, 47.7% (124) were females with a median age 36 (24 - 48) months. These were from 173 index cases from 173 households. Uptake of TPT was found to be 13.8% (36/260). Factors influencing uptake of TPT were being a contact to an index patient/ care taker who was educated about the side effects of TPT [Adjusted OR: 3.25 (95% CI: 1.55 – 6.84) p=0.002] and having at least one other person in the household who received TPT [Adjusted OR: 2.84 (95% CI: 1.41 – 5.73) p = 0.004]. Conclusion and recommendations: Approximately 1 in 10 children (13.8%) of those eligible to receive TPT were initiated on preventive therapy and nearly all had completed the treatment at the time of the study. Under-five contacts that lived in a household in which at least one person had received TPT were more likely to receive TPT. Under-five contacts to index cases who were not given information on side effects of TPT by health workers were less likely to receive the prophylactic treatment. We recommend therefore that health workers should routinely offer health education on the benefits and side effects of TPT household contacts in line with TB prevention and treatment guidelines.