48th Union World Conference: Review finds missed opportunities for preventive therapy for children with HIV in Swaziland

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Science Speaks covered the 48th Union World Conference on Lung Health in Guadalajara, Mexico Oct. 11-14.

GUADALAJARA, Mexico – While the vulnerability of children with HIV to tuberculosis has prompted World Health Organization guidelines recommending TB preventive therapy for children with the virus who are over a year old, a review of patient data across 10 years at a Swaziland center providing care to about a fifth of all children with HIV in the high-burden country found that just 55 percent of eligible children were prescribed the treatment, a presenter here said Oct. 12.

“We had a strong programmatic emphasis on isoniazid preventive therapy prescribing and we wanted to see if some pediatric patients were more likely to receive IPT, and whether some pediatric patients were more or less likely to take It,” said Dr. Alexander Kay of the Baylor Center of Excellence in Mbabane, Swaziland.

He noted that providers were sometimes reluctant to prescribe TB preventive therapy to patients who were having difficulty adhering to their antiretroviral therapy. “We also wanted to look at what the risk factors might be for developing tuberculosis after preventive therapy.”

The review found that children younger than five were more likely to receive preventive therapy, while patients who were older than 14 and had adherence to clinic visits and antiretroviral therapy of under 95 percent were less likely to have IPT prescribed. Notably, some of those patients with lower adherence who were prescribed TB preventive therapy showed improved adherence during the 6-month preventive therapy period. When adolescent patients and primary care givers were questioned about barriers to consistently taking TB preventive medicine, “barriers were less related to pill burden and more to transportation, cost, and time,” Kay said.

Children who had previously had tuberculosis were less likely to get preventive therapy.  Dr. Kay speculated that providers might have erroneously thought that a history of TB disease was protective for future acquisition of tuberculosis

Children and adolescents who were not taking antiretroviral therapy when they were taking IPT and those with more compromised immune systems were more likely to develop TB disease after they completed the regimen. Twenty percent of patients who had taken TB preventive therapy more than four years ago developed TB disease. 

In addition to noting  missed opportunities for TB preventive therapy prescription Dr. Kay highlighted the potential benefit of additional courses of preventive therapy for children with HIV in high TB burden areas.

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