UCSF

An estimated 8.7 million individuals worldwide are infected with the bacillus mycobacterium tuberculosis, with 1.4 million deaths from tuberculosis (TB) in 2011. A 9-month course of isoniazid therapy is a standard regimen to treat children with latent tuberculosis infection (LTBI) and to prevent development of active tuberculosis later in life. Given evidence from past studies, the predictors for adherence to therapy are not fully understood in affected populations, particularly in children. The aim of this dissertation was to expand knowledge on medication adherence among children with LTBI by examining factors contributing to adherence. Three key findings from this study include: 1) TB has different meanings to different cultural groups based on social context; 2) successful completion of isoniazid therapy in children was influenced by age, ethnicity, and symptoms of adverse reactions; and 3) isoniazid hepatotoxicity in children less than 21 years of age may be more common than previously thought and may be diagnosed by monitoring symptoms, physical examination, and serum transaminase levels. Treatment of LTBI is a critical step to eliminate TB in children. To promote adherence to the treatment in children, clinicians need to facilitate parental and family involvement in the treatment decision, have high awareness of symptoms of adverse reactions, and consider cultural variation in the development of interventions aimed at improving adherence to the treatment.