title: Determinants of tuberculosis treatment completion among newborns in a high-burden setting.
abstract: BACKGROUND
  Newborns exposed to Mycobacterium tuberculosis are at high risk of progression to tuberculosis (TB) disease.
  
  
  METHODS
  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.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Bekker
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: A L
authors.initials: AL
authors.lastname: Slogrove
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Du Preez
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
mesh_terms: D000328:Adult; D000367:Age Factors; D000995:Antitubercular Agents / Q000627:therapeutic use*; D017028:Caregivers; D016009:Chi-Square Distribution; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D009035:Mothers; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa; D013997:Time Factors; D016896:Treatment Outcome; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid