Facilitators And Barriers To Uptake Of Child-Friendly 3 Months Of Isoniazid And Rifampicin (3Hr) Fixed Drug Combination (Fdc) For Tuberculosis Preventive Therapy (Tpt) In Nigeria

The uptake of TB preventive therapy (TPT) for child and adult contacts of index TB patients in Nigeria has been suboptimal. Nigeria introduced the 3-month isoniazid-rifampicin (3HR) shorter regimen TPT for all eligible contacts through the USAID-funded Stop TB Partnership introducing New Tools Project (iNTP). This study assesses the facilitators and barriers to the uptake of the newly introduced child-friendly 3HR TPT for child contacts of TB patients in Nigeria. This was a cross-sectional descriptive study using mixed methods. In-depth interviews were conducted among 36 purposely selected Healthcare Workers (HCWs) and 36 caregivers of child contacts. Records of TPT-eligible child contacts (0-14 years) from April to September 2022 were retrospectively extracted. Study data were analyzed using appropriate statistical tools for qualitative and quantitative techniques. There were 7,906 child contacts identified, of which 7,902 (99.9%) contacts were screened for TB, 1,704 (21.5%) were presumptive, 264 (15.5%) diagnosed with TB, and 6,994 were eligible for TB Preventive Therapy. Additionally, out of 6,994 eligible child contacts, 3984 (57%) were initiated on TPT with 2,982 (74,8%) enrolled on 3HR and 1,002 (25%) on 6H. Of the clients placed on 3HR, 2,499 (85%) completed treatment, 309 (10.5%) lost to follow-up, 27(0.92%) developed Tuberculosis while 48 (1.6%) interrupted treatment. The key drivers of 3HR TPT uptake among child contacts were TPT-related health education and counseling. Access barriers to 3HR TPT elicited included stigma, poverty, transportation cost, stock out, ineffective monitoring and management of side effects issues of 3HR TPT, subpar Government funding and commitment to addressing TPT implementation challenges and inadequate knowledge among HCWs and caregivers. In conclusion, 3HR-TPT uptake among child contacts of index TB patients was high. Enhanced provider training and intensive community health education should be sustained while identified individual, structural, and institutional barriers should be addressed to improve implementation.