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Union study on child TB provides a model for preventing the disease in high-burden countries

26 Oct 2018

The Union has released preliminary results of an observational study that used contact tracing to identify children at risk and placed them on preventive treatment. This has potentially saved 2,000 children under five years of age from developing TB in Benin, Burkina Faso, Cameroon and the Central African Republic (CAR).

The TITI (Transmission Investiguée de la Tuberculose Infantile) study targeted children under five living in a household with an adult diagnosed at participating TB clinics with smear-positive pulmonary TB, and enrolled them into 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 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. Children in the Benin arm of the study were given a six-month course of preventive therapy.

José Luis Castro, Executive Director of The Union said: “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.”

The preliminary results of the TITI study showed that, of the nearly 2,000 children enrolled, 90 percent were started on preventive therapy, with 92 percent of children completing their course of preventive treatment. Five percent of children were diagnosed and treated for active TB.

The World Health Organization 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).

Dr Valérie Schwoebel, Programme Manager for Francophone Africa at The Union, is hopeful that this study will encourage more national programmes to implement the shorter preventive therapy regimen and scale up prevention strategies based on the TITI model.

Speaking to journalists in the press conference where the results were announced, she said: “The preliminary results show that preventing TB with the short regimen appears to be well accepted, and that contact investigation is a feasible strategy to implement within the context of the health system.”

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