A Bekker1, A L Slogrove1, H S Schaaf1, K Du Preez1, A C Hesseling1. 1. Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Abstract
BACKGROUND: Newborns exposed to Mycobacterium tuberculosis are at high risk of progression to tuberculosis (TB) disease. DESIGN AND SETTING: A prospective cohort study conducted in Cape Town, South Africa, from January 2011 to June 2012. TB-exposed newborns requiring isoniazid preventive therapy (IPT) or anti-tuberculosis treatment were followed to 6 months of age. Appropriate tuberculosis treatment referral, maternal and socio-economic determinants were evaluated. The primary outcome, completion of treatment (6 months IPT, 3 months IPT with a negative tuberculin skin test, or 6 months' treatment for disease) was measured at 6 months. Data were collected from folders and care giver interviews. Cox regression was used to determine hazard ratios (HR) for non-completion of treatment. RESULTS: Fifty-six (63% human immunodeficiency virus [HIV] exposed) TB-exposed newborns were included; median gestational age and mean birth weight were respectively 36 weeks and 2242 g. Of the 56 newborns, 44 (79%) were followed to 6 months; 29/44 (66%) completed anti-tuberculosis treatment without study team intervention. Appropriate treatment referral was associated with a lower hazard of non-completion of treatment (unadjusted HR 0.34, 95%CI 0.12-0.93). This relationship was maintained in multivariable adjustment for maternal HIV status and type of care giver (adjusted HR 0.26, 95%CI 0.09-0.77). CONCLUSIONS: Appropriate anti-tuberculosis treatment referral improves completion of treatment in infants.
BACKGROUND: Newborns exposed to Mycobacterium tuberculosis are at high risk of progression to tuberculosis (TB) disease. DESIGN AND SETTING: A prospective cohort study conducted in Cape Town, South Africa, from January 2011 to June 2012. TB-exposed newborns requiring isoniazid preventive therapy (IPT) or anti-tuberculosis treatment were followed to 6 months of age. Appropriate tuberculosis treatment referral, maternal and socio-economic determinants were evaluated. The primary outcome, completion of treatment (6 months IPT, 3 months IPT with a negative tuberculin skin test, or 6 months' treatment for disease) was measured at 6 months. Data were collected from folders and care giver interviews. Cox regression was used to determine hazard ratios (HR) for non-completion of treatment. RESULTS: Fifty-six (63% human immunodeficiency virus [HIV] exposed) TB-exposed newborns were included; median gestational age and mean birth weight were respectively 36 weeks and 2242 g. Of the 56 newborns, 44 (79%) were followed to 6 months; 29/44 (66%) completed anti-tuberculosis treatment without study team intervention. Appropriate treatment referral was associated with a lower hazard of non-completion of treatment (unadjusted HR 0.34, 95%CI 0.12-0.93). This relationship was maintained in multivariable adjustment for maternal HIV status and type of care giver (adjusted HR 0.26, 95%CI 0.09-0.77). CONCLUSIONS: Appropriate anti-tuberculosis treatment referral improves completion of treatment in infants.