Submission ID 118556
| Issue/Objective | In a rapidly changing global health landscape, marked by shifting priorities and ongoing health inequities, ensuring consistent primary prevention of tuberculosis for children remains critical. The current World Health Organization prevention guidelines call for all child TB contacts under 5 years be commenced on tuberculosis treatment, whether preventive or curative. Despite these guidelines recommending household contact investigation and tuberculosis preventive therapy in those children testing negative for TB, implementation remains inconsistent in high-burden African countries. Several individual studies exist on screening strategies and TPT uptake, with varied study designs and results across the continent. Findings of such studies have not yet been synthesized to describe the screening approaches, prevalence of uptake, and implementation landscape for child contacts in African settings. |
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| Methodology/Approach | A systematic review and meta-analysis were conducted using PRISMA guidelines. A comprehensive search strategy was developed for four databases: CINAHL, PubMed, Embase, and Web of Science, which included peer reviewed research that evaluated the prevalence of TPT uptake in children under 5 and factors associated with acceptance of TPT. Covidence was used to facilitate a two-reviewer screening and extraction process. |
| Results | 15 studies across 17 African countries were ultimately included. Isoniazid was the primary drug used for TPT. Two studies used interventional designs, five studies conducted program implementation and the remaining studies used observational. Study-level TPT uptake among children under 5 ranged from 11.7% to 100%. A meta-analysis of proportions yielded a pooled prevalence of 72% (95% CI: 0.64-0.79), though heterogeneity was substantial (I2=99.6%). Sensitivity analyses by study design demonstrated higher pooled uptake among interventional studies (90%) compared to non-interventional studies (47%). Trim-and-fill analysis suggested publication bias is unlikely in the sample. |
| Discussion/Conclusion | This review highlights the wide variation in TPT uptake among children under 5 across African settings, largely influenced by study design and implementation approach. While interventional studies report higher uptake, heterogeneity persists, underscoring the need for consistent reporting and evaluation of paediatric TB prevention strategies. Community-based approaches are emphasized as a facilitator of TPT uptake in children under 5, and thus supports a shift away from community based-models and toward proactive, decentralized care to reach vulnerable paediatric populations. |
| Presenters and affiliations | Elizabeth Di Giacomo Johns Hopkins University School of Nursing Adam Leonard Johns Hopkins University School of Nursing Jason Farley Johns Hopkins University |
