title: Implementation and Operational Research: Implementation of the WHO 2011 Recommendations for Isoniazid Preventive Therapy (IPT) in Children Living With HIV/AIDS: A Ugandan Experience.
abstract: BACKGROUND
  Intensified tuberculosis (TB) case finding and isoniazid preventive therapy (IPT) are strongly recommended for children who are HIV infected. Data are needed to assess the feasibility of the WHO 2011 intensified tuberculosis case finding/IPT clinical algorithm.
  
  
  METHODS
  Children who are HIV infected and attending Nsambya Home Care at Nsambya Hospital, Uganda, were screened for TB following WHO recommendations. IPT was given for 6 months after excluding TB. Factors associated with time to IPT initiation were investigated by multivariate Cox proportional hazard regression. Health care workers were interviewed on reasons for delay in IPT initiation.
  
  
  RESULTS
  Among the 899 (49% male) children with HIV, 529 (58.8%) were screened for TB from January 2011 to February 2013. Children with active TB were 36/529 (6.8%), 24 (4.5%) were lost to follow-ups and 280 (52.9%) started IPT, 86/280 (30.7%) within 3 months of TB screening and 194/280 (69.3%) thereafter. Among the 529 children screened for TB, longer time to IPT initiation was independently associated with cough at TB screening (hazard ratio 0.62, P = 0.02, 95% confidence interval: 0.41 to 0.94). Four children (1% of those starting treatments) interrupted IPT because of a 5-fold increase in liver function measurements. In the survey, Health care workers reported poor adherence to antiretroviral therapy, poor attendance to periodic HIV follow-ups, and pill burden as the 3 main reasons to delay IPT.
  
  
  CONCLUSIONS
  In resource-constrained settings, considerable delays in IPT initiation may occur, particularly in children with HIV who are presenting with cough at TB screening. The good safety profile of isoniazid in antiretroviral-therapy-experienced children provides further support to IPT implementation in this population.
authors.affiliation: *Department of Mother and Child Health, University of Padova, Padova, Italy;†Nsambya Home Care of St. Raphael of St. Francis Hospital, Kampala, Uganda;‡Research Center of Montreal University Health Center (CRCHUM)-Global Health, Montreal, Québec, Canada;§Associazione Casa Accoglienza alla Vita Padre Angelo, Trento, Italy;‖Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Stellenbosch University, Tygerberg, South Africa; and¶MRC Clinical Trials Unit at UCL, London, United Kingdom.
authors.forename: Paola
authors.initials: P
authors.lastname: Costenaro
authors.forename: William
authors.initials: W
authors.lastname: Massavon
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lundin
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Nabachwa
authors.forename: Federica
authors.initials: F
authors.lastname: Fregonese
authors.forename: Erika
authors.initials: E
authors.lastname: Morelli
authors.forename: Agnes
authors.initials: A
authors.lastname: Alowo
authors.forename: Maria
authors.initials: M
authors.lastname: Nannyonga Musoke
authors.forename: Charles P
authors.initials: CP
authors.lastname: Namisi
authors.forename: Susan
authors.initials: S
authors.lastname: Kizito
authors.forename: Davide
authors.initials: D
authors.lastname: Bilardi
authors.forename: Antonio
authors.initials: A
authors.lastname: Mazza
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000293:Adolescent; D000995:Antitubercular Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000008:administration & dosage*; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014376:Tuberculosis / Q000517:prevention & control*; D014454:Uganda; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid