title: It's hard work, but it's worth it: the task of keeping children adherent to isoniazid preventive therapy.
abstract: METHODS
  Isoniazid preventive therapy (IPT) offers children protection against tuberculosis (TB), but it has been difficult to implement, particularly in developing countries.
  
  
  OBJECTIVE
  To understand what encourages or inhibits children from adhering to IPT.
  
  
  METHODS
  In-depth interviews were conducted with two parents of children adherent to IPT and two staff members from three primary health care clinics in high TB prevalence communities. Themes explored were knowledge and attitudes towards IPT, problems in accessing and adhering to treatment, and community responses.
  
  
  RESULTS
  Parents administering treatment valued it positively, realised their children's risk of TB, and were positive about the clinic. Nurses acknowledged that resistance to treatment remained, with some parents not wanting to acknowledge risk nor willing to make the effort for their children; there was also considerable misinformation about IPT. Clinic nurses acknowledged problems of staff shortages, lengthy waiting times and conflict between staff and community members. Adherence was affected by social problems, stigma about TB and its link to the human immunodeficiency virus, and the extended treatment period.
  
  
  CONCLUSIONS
  Parents who maintained adherence to the IPT regimen showed that it was possible even in very difficult circumstances. Further effort is required to improve some of the clinic services, correct misinformation, reduce stigma and provide support to parents.
authors.affiliation: Research on Health and Society, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa.
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Francis
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa ; Section on Retrovirology and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA ; The TB Initiative, Texas Children's Hospital, Houston, Texas, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Mandalakas
keywords: children; knowledge and attitude; latent tuberculous infection; parents; preventive therapy