Acceptance of preventive therapy for latent tuberculosis infection in Chinese children and adolescents: a systematic review and meta-analysis

Tuberculosis preventive treatment (TPT) is essential for pediatric tuberculosis control in children and adolescents. Evidence indicates most attrition occurs prior to TPT initiation rather than from post-initiation nonadherence. This study systematically evaluated TPT acceptance for latent tuberculosis infection (LTBI) among Chinese children and adolescents and identified key influencing factors through comprehensive database searches (PubMed, Web of Science, Embase, Cochrane, CNKI, Wanfang database, CBM, VIP) up to February 21, 2025. The heterogeneity was assessed using I2 statistics (95.770%, P < 0.001), with random-effects models employed for meta-analysis. Subgroup, meta-regression, and sensitivity analyses were performed to identify the sources of heterogeneity. Begg and Egger tests were used to detect any potential publication bias. Among 7,165 screened records, 31 eligible studies (n = 4,929) met inclusion criteria. The pooled TPT acceptance rate reached 64.0% (95%CI: 56.9%-70.9%), with significantly higher TPT acceptance rates observed among: central China residents (76.5%, 95% CI: 69.8%–82.5%), close household contacts (80.2%, 95% CI: 74.9% − 85.0%), IGRA positive (80.5%, 95% CI: 74.3% − 86.0%), recipients of isoniazid-rifapentine regimens (76.5%, 95% CI: 69.5%–82.9%), and twice-weekly dosing schedules (76.5%, 95% CI: 69.5%–82.9%). This study revealed the suboptimal uptake of TPT among children and adolescents with LTBI in China. These findings highlight the need to tailor interventions to regional epidemiological profiles, accurately identify the target population for TPT with reliable tools, and scale up optimized regimens under stringent monitoring, as these are critical strategies for enhancing TPT coverage and advancing the “End TB” initiative.