Factors Associated With Tuberculosis Preventive Therapy Uptake among Eligible Children under Fifteen Years at Kakamega County Referral Hospital, Kenya

Abstract

Background: Tuberculosis (TB) remains a significant global health concern, with efforts aimed at ending the epidemic by 2035. Tuberculosis Preventive Therapy (TPT) is a key intervention to prevent progression from latent TB infection to active disease, especially in children under fifteen, who were at higher risk particularly those living with HIV or in close contact with infectious TB cases. Despite its benefits, global TPT coverage was only 34%, and in Kenya, just 14.5% of eligible children received it. Methods: This retrospective cohort study assessed TPT uptake and outcomes among children under fifteen at Kakamega County Referral Hospital. A census approach was used, including all eligible children registered between 2020 and 2023 extracted from TB and HIV care tools. Results: TPT uptake was 72.1%, with no significant difference between children living with HIV and those in contact with bacteriologically confirmed TB. Lack of stock, distance, and decline by caregivers were the main barriers to initiation. Among BCTB contacts, completion of treatment for the index condition was the strongest predictor of TPT initiation in children. None of the measured factors predicted uptake among HIV-infected children. Conclusions: TPT uptake among eligible children at the referral hospital in Kakamega County was moderate but did not meet universal coverage targets. Among BCTB contacts, the index case's health system connection emerged as a key driver of paediatric TPT initiation. None of the individual-level factors predicted uptake among children living with HIV.