title: A mixed-methods evaluation of adherence to preventive treatment among child tuberculosis contacts in Indonesia.
abstract: Tuberculosis (TB) can be prevented using isoniazid preventive therapy (IPT) among child contacts. However, the benefits of IPT depend on adherence to at least 6 months of daily treatment. A greater understanding of the barriers to and facilitators of adherence to IPT in resource-poor settings is required to optimise the benefits.
  
  
  
  We prospectively evaluated adherence to IPT and its associated factors among child contacts (age 0-5 years) eligible for IPT. We undertook in-depth interviews with care givers and a focus group discussion with health care workers, which were thematically analysed to explore barriers to and facilitators of adherence from the perspective of both care givers and health workers.
  
  
  
  Of 99 eligible children, 49 (49.5%) did not complete 6 months of IPT. Children whose care giver collected their IPT medications from primary health centres were more likely to have incomplete adherence than those who collected them from hospitals (aOR 2.9, 95%CI 1.1-7.8). Thematic analyses revealed major barriers to and facilitators of adherence: regimen-related, care giver-related and health care-related factors, social support and access. Many of these factors are readily modifiable.
  
  
  
  Providing information about IPT and improving accessibility for care givers to receive IPT at the primary health care facility should be priorities to facilitate implementation.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Triasih
authors.affiliation: Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors.forename: R S
authors.initials: RS
authors.lastname: Padmawati
authors.affiliation: Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Duke
authors.affiliation: Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Sawyer
authors.affiliation: Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D017028:Caregivers; D002675:Child, Preschool; D016358:Contact Tracing; D004334:Drug Administration Schedule; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D007214:Indonesia; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D007538:Isoniazid / Q000008:administration & dosage*; D008297:Male; D055118:Medication Adherence; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid