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Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy

Delivery of tuberculosis preventive therapy (TPT) for children with household exposure to tuberculosis is a globally supported intervention to reduce the impact of tuberculosis disease (TB) in vulnerable children; however, it is sub-optimally implemented in most high-burden settings. As part of a co...

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Autores principales: Sandoval, Micaela, Mtetwa, Godwin, Devezin, Tara, Vambe, Debrah, Sibanda, Joyce, Dube, Gloria S., Dlamini-Simelane, Thandeka, Lukhele, Bhekumusa, Mandalakas, Anna M., Kay, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10348572/
https://www.ncbi.nlm.nih.gov/pubmed/37450473
http://dx.doi.org/10.1371/journal.pgph.0001920
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author Sandoval, Micaela
Mtetwa, Godwin
Devezin, Tara
Vambe, Debrah
Sibanda, Joyce
Dube, Gloria S.
Dlamini-Simelane, Thandeka
Lukhele, Bhekumusa
Mandalakas, Anna M.
Kay, Alexander
author_facet Sandoval, Micaela
Mtetwa, Godwin
Devezin, Tara
Vambe, Debrah
Sibanda, Joyce
Dube, Gloria S.
Dlamini-Simelane, Thandeka
Lukhele, Bhekumusa
Mandalakas, Anna M.
Kay, Alexander
author_sort Sandoval, Micaela
collection PubMed
description Delivery of tuberculosis preventive therapy (TPT) for children with household exposure to tuberculosis is a globally supported intervention to reduce the impact of tuberculosis disease (TB) in vulnerable children; however, it is sub-optimally implemented in most high-burden settings. As part of a community-based household contact management program, we evaluated predictors of adherence to community based TPT in children and performed qualitative assessments of caregiver experiences. The Vikela Ekhaya (Protect the Home) project was a community-based household contact management program implemented between 2019 and 2020 in the Hhohho Region of Eswatini. At home visits, contact management teams screened children for TB, initiated TPT when indicated and performed follow-up assessments reviewing TPT adherence. TPT non-adherence was defined as either two self-reported missed doses or a pill count indicating at least two missed doses, and risk factors were evaluated using multivariate clustered Cox regression models. Semi-structured interviews were performed with caregivers to assess acceptability of home visits for TPT administration. In total, 278 children under 15 years initiated TPT and 96% completed TPT through the Vikela Ekhaya project. Risk factors for TPT non-adherence among children initiating 3HR included low family income (adjusted hazard ratio (aHR) 2.3, 95%CI 1.2–4.4), female gender of the child (aHR 2.5, 95% CI 1.4–5.0) and an urban living environment (aHR 3.1, 95%CI 1.6–6.0). Children with non-adherence at the first follow-up visit were 9.1 fold more likely not to complete therapy. Caregivers indicated an appreciation for community services, citing increased comfort, reduced cost, and support from community members. Our results are supportive of recent World Health Organization (WHO) recommendations for decentralization of TB preventive services. Here, we identify populations that may benefit from additional support to promote TPT adherence, but overall demonstrate a clear preference for and excellent outcomes with community based TPT delivery.
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spelling pubmed-103485722023-07-15 Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy Sandoval, Micaela Mtetwa, Godwin Devezin, Tara Vambe, Debrah Sibanda, Joyce Dube, Gloria S. Dlamini-Simelane, Thandeka Lukhele, Bhekumusa Mandalakas, Anna M. Kay, Alexander PLOS Glob Public Health Research Article Delivery of tuberculosis preventive therapy (TPT) for children with household exposure to tuberculosis is a globally supported intervention to reduce the impact of tuberculosis disease (TB) in vulnerable children; however, it is sub-optimally implemented in most high-burden settings. As part of a community-based household contact management program, we evaluated predictors of adherence to community based TPT in children and performed qualitative assessments of caregiver experiences. The Vikela Ekhaya (Protect the Home) project was a community-based household contact management program implemented between 2019 and 2020 in the Hhohho Region of Eswatini. At home visits, contact management teams screened children for TB, initiated TPT when indicated and performed follow-up assessments reviewing TPT adherence. TPT non-adherence was defined as either two self-reported missed doses or a pill count indicating at least two missed doses, and risk factors were evaluated using multivariate clustered Cox regression models. Semi-structured interviews were performed with caregivers to assess acceptability of home visits for TPT administration. In total, 278 children under 15 years initiated TPT and 96% completed TPT through the Vikela Ekhaya project. Risk factors for TPT non-adherence among children initiating 3HR included low family income (adjusted hazard ratio (aHR) 2.3, 95%CI 1.2–4.4), female gender of the child (aHR 2.5, 95% CI 1.4–5.0) and an urban living environment (aHR 3.1, 95%CI 1.6–6.0). Children with non-adherence at the first follow-up visit were 9.1 fold more likely not to complete therapy. Caregivers indicated an appreciation for community services, citing increased comfort, reduced cost, and support from community members. Our results are supportive of recent World Health Organization (WHO) recommendations for decentralization of TB preventive services. Here, we identify populations that may benefit from additional support to promote TPT adherence, but overall demonstrate a clear preference for and excellent outcomes with community based TPT delivery. Public Library of Science 2023-07-14 /pmc/articles/PMC10348572/ /pubmed/37450473 http://dx.doi.org/10.1371/journal.pgph.0001920 Text en © 2023 Sandoval et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sandoval, Micaela
Mtetwa, Godwin
Devezin, Tara
Vambe, Debrah
Sibanda, Joyce
Dube, Gloria S.
Dlamini-Simelane, Thandeka
Lukhele, Bhekumusa
Mandalakas, Anna M.
Kay, Alexander
Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy
title Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy
title_full Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy
title_fullStr Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy
title_full_unstemmed Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy
title_short Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy
title_sort community-based tuberculosis contact management: caregiver experience and factors promoting adherence to preventive therapy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10348572/
https://www.ncbi.nlm.nih.gov/pubmed/37450473
http://dx.doi.org/10.1371/journal.pgph.0001920
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