Preventive therapy for children following contact with a tuberculosis source case: cause for debate in a high-burden setting?

Abstract

The identifcation of vulnerable children following contact with an infectious tuberculosis source case, and their subsequent treatment with effective preventive therapy, reduces the risk of tuberculosis disease progression. The majority of countries in the world recommend preventive therapy for young and human immunodefciency virus-infected children, and yet in most low-resource countries, where the highest burden of tuberculosis exists, delivery is incomplete and inadequate. This opinion paper discusses the provision of preventive therapy in children living in a high-burden setting. It presents the arguments offered by both sides in the debate, and provides the evidence cited by both positions. Finally, the article suggests interventions that could be investigated to improve the uptake of preventive therapy should it be advocated.