New studies demonstrate drastic reductions in the length of time patients need to stay on preventative tuberculosis (TB) therapy
A study undertaken by the International Union for Tuberculosis and Lung Disease (The Union) – and announced at the 49th Union World Conference on Lung Health – has potentially saved 2000 children under five years of age from developing TB in Benin, Burkina Faso, Cameroon and the Central African Republic.
The TITI (Transmission Investiguée de la Tuberculose Infantile) Study explored methods to reduce the number of children who fall ill to TB by finding all children at increased risk and placing them on treatments aimed at preventing TB.
The World Health Organization (WHO) strongly recommends TB preventive therapy to children under the age of five who are household contacts of bacteriologically confirmed TB cases. Yet only 23 percent of an estimated 1.3 million children under the age of five who were household TB contacts and eligible for TB preventive therapy actually received it. (WHO Global TB Report 2018).
The TITI study targeted children under five living in a household with an adult diagnosed with smear-positive pulmonary TB at participating TB clinics, and enrolled them onto the study after obtaining their parents’ informed consent. Children were evaluated during home and clinic visits using a standardised questionnaire, clinical examination, tuberculin skin test (TST) and chest radiography. Children free of active TB were offered preventive treatment using a shorter regimen of rifampicin–isoniazid (RH75/50) for three months in Burkina-Faso, Cameroon and CAR, which reduces by half the duration of the six-month regimen of isoniazid used in most countries.
The preliminary results of the TITI study showed that of the nearly 2,000 children enrolled in the study, 90 percent were started on preventive therapy, with 92 percent of children completing their course of preventive treatment. Five percent of children were diagnosed with active TB and placed on treatment.
José Luis Castro, Executive Director of The Union said: “Children with TB have been widely neglected by health systems, but the human-rights-based TB agenda established at the recent United Nations High-Level Meeting on TB sends a clear signal that such scandalous practices will no longer be tolerated at any level of the response.
“Worldwide today, very few children who are exposed to TB infection in their own homes are provided preventive therapy to protect them from becoming sick. Studies like The Union’s TITI study can make a huge difference to the response rate, and provide a vital way to ensure the rights of every child are respected.”
Today’s press conference highlighted four abstracts being presented at the 49thUnion World Conference on Lung Health 2018. (Note: Press summaries are based on abstracts; final data presented at the conference may change).
Implementation of systematic investigation and preventive therapy in children under 5 years living with smear-positive pulmonary tuberculosis adult in four French-speaking African countries
TITI study (“Transmission Investiguee de la Tuberculose Infantile”: contact investigation for childhood TB) was an implementation study, conducted in the capital cities of four francophone countries (Benin, Burkina Faso, Cameroon, Central African Republic) since the end of 2015. The study was coordinated by The Union and funded by France’s 5% Initiative.
Valerie Schwoebel, Program Manager, Francophone Africa at the International Union Against Tuberculosis and Lung Disease (The Union) reported that these children were evaluated during home and clinic visits using a standardised questionnaire, clinical examination, TST and chest radiography. Children free of active TB were offered preventive treatment using isoniazid for six months in Benin, or rifampicin–isoniazid (RH75/50) for three months in other countries.
Training of NTP nurses was organised before the study started and standardized tools (weighing scales, preventive treatment register, chest radiography form, drug dosage charts) were distributed.
The inclusion process lasted 18-months up to the end of September 2017, during which 4300 patients notified with smear-positive pulmonary TB in the participating facilities were interviewed for eligibility.
Close to 2000 child contacts were included in the study
- 5% of them were diagnosed with active TB
- 90% were started on preventive treatment
- Attendance to monthly visits during treatment was good, with over 90% of children completing their course of preventive treatment
- No serious adverse events were reported.
- Follow-up after the end of treatment completion is still ongoing.
Abstract: Implementation of systematic investigation and preventive therapy in children under 5 years living with smear-positive pulmonary tuberculosis adult in four French-speaking African countries