{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:21:36Z","timestamp":1793402496886,"version":"4.5.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["1K01TW011482-01A1"],"award-info":[{"award-number":["1K01TW011482-01A1"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stop TB Partnership"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Delivery of tuberculosis preventive therapy (TPT) for children with household exposure to tuberculosis is a globally supported intervention to reduce the impact of tuberculosis disease (TB) in vulnerable children; however, it is sub-optimally implemented in most high-burden settings. As part of a community-based household contact management program, we evaluated predictors of adherence to community based TPT in children and performed qualitative assessments of caregiver experiences. The Vikela Ekhaya (Protect the Home) project was a community-based household contact management program implemented between 2019 and 2020 in the Hhohho Region of Eswatini. At home visits, contact management teams screened children for TB, initiated TPT when indicated and performed follow-up assessments reviewing TPT adherence. TPT non-adherence was defined as either two self-reported missed doses or a pill count indicating at least two missed doses, and risk factors were evaluated using multivariate clustered Cox regression models. Semi-structured interviews were performed with caregivers to assess acceptability of home visits for TPT administration. In total, 278 children under 15 years initiated TPT and 96% completed TPT through the Vikela Ekhaya project. Risk factors for TPT non-adherence among children initiating 3HR included low family income (adjusted hazard ratio (aHR) 2.3, 95%CI 1.2\u20134.4), female gender of the child (aHR 2.5, 95% CI 1.4\u20135.0) and an urban living environment (aHR 3.1, 95%CI 1.6\u20136.0). Children with non-adherence at the first follow-up visit were 9.1 fold more likely not to complete therapy. Caregivers indicated an appreciation for community services, citing increased comfort, reduced cost, and support from community members. Our results are supportive of recent World Health Organization (WHO) recommendations for decentralization of TB preventive services. Here, we identify populations that may benefit from additional support to promote TPT adherence, but overall demonstrate a clear preference for and excellent outcomes with community based TPT delivery.<\/jats:p>","DOI":"10.1371\/journal.pgph.0001920","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T17:23:15Z","timestamp":1689355395000},"page":"e0001920","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0777-3933","authenticated-orcid":true,"given":"Micaela","family":"Sandoval","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godwin","family":"Mtetwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9858-2544","authenticated-orcid":true,"given":"Tara","family":"Devezin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0264-1165","authenticated-orcid":true,"given":"Debrah","family":"Vambe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Sibanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria S.","family":"Dube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thandeka","family":"Dlamini-Simelane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhekumusa","family":"Lukhele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Mandalakas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5283-4697","authenticated-orcid":true,"given":"Alexander","family":"Kay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"pgph.0001920.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2334-14-91","article-title":"Efficacy of isoniazid prophylactic therapy in prevention of tuberculosis in children:a meta\\textendashanalysis","volume":"14","author":"J Ayieko","year":"2014","journal-title":"BMC Infect Dis"},{"key":"pgph.0001920.ref002","first-page":"827","article-title":"Isoniazid Prophylaxis Among Alaskan Eskimos: A Final Report of the Bethel Isoniazid Studies","volume":"119","author":"GW Comstock","year":"1979","journal-title":"Am Rev Respir Dis"},{"key":"pgph.0001920.ref003","article-title":"Tuberculosis prevention in children: A prospective community based study in South Africa","author":"AM Mandalakas","year":"2020","journal-title":"Eur Respir J"},{"key":"pgph.0001920.ref004","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S0140-6736(20)30166-5","article-title":"The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis","volume":"395","author":"L Martinez","year":"2020","journal-title":"Lancet"},{"key":"pgph.0001920.ref005","first-page":"392","article-title":"The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era","volume":"8","author":"BJBJ Marais","year":"2004","journal-title":"Int J Tuberc Lung Dis"},{"key":"pgph.0001920.ref006","article-title":"Distinct Risk Factors for Clinical and Bacteriologically Confirmed Tuberculosis among Child Household Contacts in a High-Burden Setting","author":"M Sandoval","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0001920.ref007","first-page":"86","article-title":"WHO consolidated guidelines on tuberculosis. 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