Isoniazid prophylaxis to children at the Baylor College of Medicine-Bristol Myers Squibb Children\u27s Clinical Centre of Excellence Swaziland: A follow-up study

Background: Tuberculosis (TB) is a leading cause of death in HIV-positive children in sub-Saharan Africa. In 2010 the World Health Organization (WHO) recommended providing isoniazid preventive therapy (IPT) prophylaxis to all HIV-positive children above 12 months of age. This study evaluates the administration of IPT to HIV-positive children attending the Baylor College of Medicine-Bristol Myers Squibb Children’s Clinical Centre of Excellence (COE), a pediatric HIV clinic in Mbabane, Swaziland. ^ Methods: A retrospective chart review was conducted to capture all HIV-positive children aged three months to 14 years of age who received IPT between January 1, 2008 and December 31, 2010. Demographic data were documented, as well as isoniazid completion, adherence and medication side effects. Charts were reviewed through May 31, 2013 to record outcomes including death, lost to follow up, and interval development of TB disease. TB diagnostic criteria for each patient with TB disease were noted. ^ Results: Of 168 children receiving IPT, 144 (86%) completed six months of treatment. One hundred forty-five (86%) were on antiretroviral therapy while receiving IPT. Adherence was recorded in 27% of children. Four (2%) experienced side effects requiring isoniazid cessation. One patient died during treatment of suspected myocarditis. Ten (6%) were treated for TB after receiving IPT; three of the 10 were started on isoniazid and subsequently switched to TB disease treatment. Eleven (7%) of children were lost-to-follow-up or transferred out of clinic during or after IPT administration. ^ Conclusions: Isoniazid provided to HIV-positive children in a resource-limited setting is safe and feasible. Few developed side effects that resulted in medication cessation. Six percent of the population developed TB, which is comparable to other studies in sub-Saharan Africa evaluating TB in HIV-positive children receiving isoniazid. More research must be conducted to determine best methods of operationalizing IPT distribution to all who would benefit.