A community-based Isoniazid preventive therapy for the prevention of childhood tuberculosis in Ethiopia.

Background: Children in contact with adults with tuberculosis should receive Isoniazid preventive therapy (IPT) but this is rarely implemented.

Aim: To assess whether a community-based approach providing IPT at household level improves uptake and adherence in Ethiopia.

Methods: Contacts of adults with smear-positive pulmonary TB (PTB+) were visited at home and examined by Health Extension Workers (HEWs). Asymptomatic children <5 years were offered IPT and followed monthly.

Results: 5,345 (87%) of 6,161 PTB+ cases identified by the HEWs in the community were visited, identifying 24,267 contacts. 7,226 (29.8%) contacts were children <15 and 3,102 (12.7%) of them were <5 years old. 2,949 contacts had symptoms of TB and 1,336 submitted sputum for examination. 92 (6.9%) had PTB+ and 169 all forms of TB. Of 3,027 asymptomatic children, only 1,761 were offered (and accepted) IPT due to isoniazid shortages. Of these, 1,615 (91.7%) completed the 6-month course. The most frequent reason for discontinuing IPT was also Isoniazid shortages.

Interpretation: contact tracing contributed to detection of additional TB cases and provision of IPT for young children. Delivery of IPT in the community alongside community-based TB interventions resulted in better acceptance and improved treatment outcome.