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

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.

Preventive Therapy, Tuberculosis, TPT Outcomes, Children, Kakamega, Kenya

1. CDC. About tuberculosis 2025 [cited 2026. Available from: https://www.cdc.gov/tb/es/about/la-tuberculosis.html. [Google Scholar] [Crossref]

2. WHO. Global tuberculosis report 2025. 2025. [Google Scholar] [Crossref]

3. Pai M, Furin J. Tuberculosis innovations mean little if they cannot save lives. eLife. 2017;6:e25956. [Google Scholar] [Crossref]

4. MOH. Epidemiology of Tuberculosis and Leprosy in Kenya. In: diseases DoTaol, editor. 2023. [Google Scholar] [Crossref]

5. WHO. Tuberculosis in the WHO African Region: 2023 progress update Brazzaville: WHO African Region2023 [cited 2025. Available from: https://www.afro.who.int/sites/default/files/2023-09/Tuberculosis%20in%20the%20African%20Region_2023%20report.pdf. [Google Scholar] [Crossref]

6. Menzies NA, Wolf E, Connors D, Bellerose M, Sbarra AN, Cohen T, et al. Progression from latent infection to active disease in dynamic tuberculosis transmission models: a systematic review of the validity of modelling assumptions. The Lancet Infectious Diseases. 2018;18(8):e228-e38. [Google Scholar] [Crossref]

7. WHO. WHO consolidated guidelines on tuberculosis: module 1: prevention: tuberculosis preventive treatment. Geneva: World Health Organization; 2020 2020. [Google Scholar] [Crossref]

8. Kassaw A, Asferie WN, Azmeraw M, Kefale D, Kerebih G, Mekonnen GB, et al. Incidence and predictors of tuberculosis among HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. Plos one. 2024;19(7):e0306651. [Google Scholar] [Crossref]

9. Vonasek BJ, Rabie H, Hesseling AC, Garcia-Prats AJ. Tuberculosis in Children Living With HIV: Ongoing Progress and Challenges. Journal of the Pediatric Infectious Diseases Society. 2022;11(Supplement_3):S72-S8. [Google Scholar] [Crossref]

10. WHO. WHO consolidated guidelines on tuberculosis Module 1: prevention. 2024. [Google Scholar] [Crossref]

11. Kariuki N, Macharia E, Marangu D. Uptake of tuberculosis preventive therapy among eligible children under five years in Mombasa County, Kenya-mixed methods observational study. East African Medical Journal. 2023;100(10):6384. [Google Scholar] [Crossref]

12. Macharia E. Uptake of Tuberculosis Preventive Therapy Among Eligible Children Under Five Years in Mombasa County: University of Nairobi; 2021. [Google Scholar] [Crossref]

13. Burmen B, Mutai K, Malika T. Isoniazid Preventative Therapy uptake for child household contacts of tuberculosis index cases, Kisumu County, Kenya, 2014-2015. Journal of Public Health in Africa. 2019;10(1):24–30. [Google Scholar] [Crossref]

14. Amisi JA, Carter EJ, Masini E, Szkwarko D. Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya. BMJ Open. 2021;11(2):e040993. [Google Scholar] [Crossref]

15. Onyango DO, van der Sande MAB, Yuen CM, Mecha J, Matemo D, Oele E, et al. Drop-offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019. Journal of the International AIDS Society. 2022;25(8):e25939. [Google Scholar] [Crossref]

16. Carter EJ, Mungai B, Njoroge T, Masese A, Szkwarko D, Angala P, et al. Finding the missing children for TB care and prevention in Kenya. The International Journal of Tuberculosis and Lung Disease: the Official Journal of the International Union Against Tuberculosis and Lung Disease. 2022;26(12):1144-50. [Google Scholar] [Crossref]

17. Houben RMGJ, Dodd PJ. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS medicine. 2016;13(10):e1002152. [Google Scholar] [Crossref]

18. Dodd PJ, Gardiner E, Coghlan R, Seddon JA. Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study. The lancet global health. 2014;2(8):e453-e9. [Google Scholar] [Crossref]

19. Graham SM, Marais BJ, Amanullah F. Tuberculosis in Children and Adolescents: Progress and Perseverance. Pathogens [Internet]. 2022; 11(4). [Google Scholar] [Crossref]

20. Strauss M, Wademan DT, McInziba A, Hoddinott G, Rafique M, Jola LN, et al. TB preventive therapy preferences among children and adolescents. The International Journal of Tuberculosis and Lung Disease. 2023;27(7):520-9. [Google Scholar] [Crossref]

21. Adjobimey M, Ade S, Wachinou P, Esse M, Yaha L, Bekou W, et al. Prevalence, acceptability, and cost of routine screening for pulmonary tuberculosis among pregnant women in Cotonou, Benin. PLoS One. 2022;17(2):e0264206. [Google Scholar] [Crossref]

22. Nicol MP, Zar HJ. Advances in the diagnosis of pulmonary tuberculosis in children. Paediatric respiratory reviews. 2020;36:52-6. [Google Scholar] [Crossref]

23. Kalaman CR, Ibrahim N, Shaker V, Cham CQ, Ho MC, Visvalingam U, et al. Parental Factors Associated with Child or Adolescent Medication Adherence: A Systematic Review. Healthcare. 2023;11(4):501. [Google Scholar] [Crossref]

24. CHS. Analysis of Tuberculosis Case Finding Strategies, Tuberculosis Preventive Therapy Uptake, and Tuberculosis Treatment Outcomes Among Clients in General Outpatient Setting and People Living with HIV in Siaya County, Kenya. 2021. [Google Scholar] [Crossref]

25. NASCOP. Kenya HIV program performance: Pediatric and adolescent HIV data highlights 2023 [Available from: https://ke.usembassy.gov/pepfar/. [Google Scholar] [Crossref]

26. Seid G, Alemu A, Diriba G, Zerihun B, Abebaw Y, Moga S, et al. Routine tuberculosis contact investigation yield and preventive treatment cascade in central Ethiopia. Heliyon. 2024;10(10). [Google Scholar] [Crossref]

27. Ngugi SK, Muiruri P, Odero T, Gachuno O. Factors affecting uptake and completion of isoniazid preventive therapy among HIV-infected children at a national referral hospital, Kenya: a mixed quantitative and qualitative study. BMC Infectious Diseases. 2020;20(1):294. [Google Scholar] [Crossref]

28. Peninah MM, Dalton W, Diana M, Murima Naa. Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study. East African Health Research Journal. 2019;3(2):141-50. [Google Scholar] [Crossref]

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