Children and adolescents on TPT should be reviewed every month for those on a 3-month regimen (e.g. 3HR or 3HP), or every 2 months for those on a 6-month regimen (e.g. 6H) or DR-TB TPT, ideally at a health care facility or by treatment supporters (see Section 6.4) or by using digital tools such as video-supported treatment (69). If possible and feasible, aligning visits with care for the index patient is an important consideration, especially when the child or adolescent contact and the index patient
are from the same family.
It may be challenging for families to understand why a child who is well should take medicine every day or every week for 3–6 months to protect them from developing TB disease, and it is important to explain the reasons clearly. The importance of adherence should be reinforced at every visit. Children can also be reviewed at home with the provision of monthly TPT supplies. In some settings, this can be coordinated with home treatment support of adult index or source patients.
Follow-up visits should include the following (a “TPT passport” or similar TPT record may help with the consistent achievement of these aims – see Annex 1 for available resources):
- Monitor for TB symptoms (e.g. cough, fever, fatigue, poor weight gain, reduced playfulness):
- evaluation for TB disease if symptoms or signs suggestive of TB develop;
- management of breakthrough TB (TB disease that develops while on TPT) – in this case, it is recommended to stop TPT and initiate TB treatment, and to send specimens for Xpert MTB/RIF or Ultra, line probe assay (LPA) or DST as appropriate and feasible.
- Monitor weight to check appropriate TPT dosage (to adjust if crossing weight bands) and for evidence of TB disease.
- Monitor for and manage adverse events as relevant to the prescribed TPT regimen – see Chapter 6 in the WHO operational handbook on tuberculosis. Module 1: prevention – tuberculosis preventive treatment (15).
- Monitor for adherence to treatment and conduct pill counts. If adherence to treatment is poor or there is an interruption to TPT, the HCW should enquire about the possible reasons and discuss options with the child’s parent or guardian, taking the opportunity to express support for the family and to address any issues that may require referral or treatment. Counselling should be offered in a way that makes the family feel empowered in their choice to continue with TPT (see Section 3.3.8).
- Ensure recording and reporting – all children and adolescents on TPT should be registered to collect information about monitoring the uptake of, adherence to and outcome of TPT (including breakthrough TB), and requirements for procurement to avoid stockouts of medicines. Data can be recorded in contact investigation registers or in separate TPT registers. Refer to the WHO operational handbook on tuberculosis. Module 1: prevention – tuberculosis preventive treatment for a minimum set of indicators for monitoring programmatic management of TPT, focused on assessment of contacts of people with TB, assessment of people living with HIV and other at-risk groups, and initiation and completion of TPT.
- The PREVENT-TB tool, an application which allows monitoring throughout the cascade of preventive care, is available at https://www.who.int/activities/preventing-tb#app. Indicators for TB screening and TPT are available on the TB Knowledge Sharing Platform (see https://tbksp.org/en/node/628 and Figure 2.5 at https://tbksp.org/en/node/1401).