Facility and patient barriers in the implementation of isoniazid preventive therapy for people living with HIV attending Care and Treatment Centers, Songea Municipality, Tanzania

Background Information on how well Isoniazid Preventive Therapy (IPT) works on reducing TB incidence among people living with HIV (PLHIV) in routine settings using robust statistical methods to establish causality in observational studies is scarce. Objectives To evaluate the effectiveness of IPT in routine clinical settings by comparing TB incidence between IPT and non-IPT groups. Methods We used data from PLHIV enrolled in 315 HIV care and treatment clinic from January 2012 to December 2016. We used Inverse Probability of Treatment Weighting to adjust for the probability of receiving IPT; balancing the baseline covariates between IPT and non-IPT groups. The effectiveness of IPT on TB incidence was estimated using Cox regression using the weighted sample. Results Of 171,743 PLHIV enrolled in the clinics over the five years, 10,326 (6.01%) were excluded leaving 161,417 available for the analysis. Of the 24,800 who received IPT, 1.00% developed TB disease whereas of the 136,617 who never received IPT 6,085 (4.98%) developed TB disease. In 278,545.90 person-years of follow up, a total 7,052 new TB cases were diagnosed. Using the weighted sample, the overall TB incidence was 11.57 (95% CI: 11.09–12.07) per 1,000 person-years. The TB incidence among PLHIV who received IPT was 10.49 (95% CI: 9.11–12.15) per 1,000 person-years and 12.00 (95% CI: 11.69–12.33) per 1,000 person-years in those who never received IPT. After adjusting for other covariates there was 52% lower risk of developing TB disease among those who received IPT compared to those who never received IPT: aHR = 0.48 (95% CI: 0.40–0.58, P<0.001). Conclusion IPT reduced TB incidence by 52% in PLHIV attending routine CTC in Tanzania. IPTW adjusted the groups for imbalances in the covariates associated with receiving IPT to achieve comparable groups of IPT and non-IPT. This study has added evidence on the effectiveness of IPT in routine clinical settings and on the use of IPTW to determine impact of interventions in observational studies.

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PIN60 Effect of Community Based Intervention on Isoniazid Preventive Therapy Uptake Among People Living with HIV in FAR Western Province of Nepal: A Cluster Randomized Controlled Trial

Value in Health ◽

10.1016/j.jval.2021.04.1248 ◽

2021 ◽

Vol 24 ◽

pp. S116-S117

Author(s):

G. Dhungana ◽

D.R. Bhatta ◽

W.H. Zhang

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Preventive Therapy ◽

Isoniazid Preventive Therapy ◽

People Living With Hiv ◽

Community Based ◽

Randomized Controlled ◽

Western Province ◽

Cluster Randomized ◽

Living With Hiv

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Programmatic Evaluation of an Algorithm for Intensified Tuberculosis Case Finding and Isoniazid Preventive Therapy for People Living With HIV in Thailand and Vietnam

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000001551 ◽

2017 ◽

Vol 76 (5) ◽

pp. 512-521 ◽

Cited By ~ 1

Author(s):

Tori L. Cowger ◽

Le Hung Thai ◽

Bui Duc Duong ◽

Junya Danyuttapolchai ◽

Somyot Kittimunkong ◽

...

Keyword(s):

Preventive Therapy ◽

Case Finding ◽

Isoniazid Preventive Therapy ◽

People Living With Hiv ◽

Tuberculosis Case ◽

Programmatic Evaluation ◽

Living With Hiv

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Knowledge and adherence to isoniazid preventive therapy among people living with HIV (PLHIV) in multilevel health facilities in South-East, Nigeria: baseline findings from a quasi-experimental study

Pan African Medical Journal ◽

10.11604/pamj.2020.36.261.22496 ◽

2020 ◽

Vol 36 ◽

Author(s):

Ifeyinwa Chizoba Akamike ◽

Ijeoma Nina Okedo-Alex ◽

Adaoha Pearl Agu ◽

Chihurumnanya Alo ◽

Lawrence Ulu Ogbonnaya

Keyword(s):

Experimental Study ◽

Preventive Therapy ◽

Health Facilities ◽

Isoniazid Preventive Therapy ◽

People Living With Hiv ◽

Quasi Experimental ◽

Living With Hiv

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Evaluation of routine Isoniazid Preventive Therapy among People Living with HIV for reducing Tuberculosis; a retrospective cohort study in Tanzania (2012-2016)

10.21203/rs.3.rs-19503/v1 ◽

2020 ◽

Author(s):

Werner Maokola ◽

Bernard Ngowi ◽

Lovett Lawson ◽

Michael Mahande ◽

Jim Todd ◽

...

Keyword(s):

Cohort Study ◽

Functional Status ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Scale Up ◽

Preventive Therapy ◽

Isoniazid Preventive Therapy ◽

Hiv Care ◽

People Living With Hiv ◽

Living With Hiv

Abstract Background: Isoniazid Preventive Therapy (IPT) reduced Tuberculosis (TB) among People Living with HIV (PLHIV). Despite this, uptake has been reported to be sub-optimal . We describe characteristics of visits in which PLHIV were screened TB negative (as the main source for IPT initiation), determine characteristics of visits in which PLHIV were initiated on IPT as well as determined factors associated with IPT initiation to inform program scale up and improve quality of service.Methods : Retrospective cohort study design which involved PLHIV enrolled into care and treatment clinics in Dar es Salaam, Iringa and Njombe regions from January 2012 to December 2016. The study aimed at evaluating implementation of IPT among PLHIV. Data analysis was conducted using STATA.Results: A total 173,746 were enrolled in CTC in the 3 regions during the period of follow up and made a total of 2,638,876 visits. Of the eligible visits, only 24,429 (1.26%) were initiated on IPT. In multivariate analysis, 50 years and more (aOR=3.42, 95% CI: 3.07-3.82, P<0.01), bedridden functional status individuals with bedridden functional status (aOR=4.56, 95% CI:2.45-8.49, P<0.01) and WHO clinical stage II had higher odds of IPT initiation (aOR=1.18, 95% CI:1.13-1.23, P<0.01). Furthermore, enrolment in 2016 (aOR=2.92, 95% CI:2.79-3.06, P<0.01), enrolment in hospitals (aOR=1.84, 95% CI:1.77-1.90, P<0.01), enrolment in public health facilities (aOR=1.82, 95% CI: 1.75-1.90, P<0.01) and been on care for more than one year (aOR=6.77, 95% CI: 5.25-8.73, P<0.000) were also more likely to be initiated on IPT. Enrollment in Iringa (aOR=0.44, 95% CI: 0.41-0.47, P<0.01) and good adherence (aOR=0.56, 95% CI 0.47-0.67, P<0.01) was less likely to be initiated on IPT.Conclusions: Our study documented low IPT initiation proportion among those who were enrolled in HIV care and eligible in the 3 regions during the study period. Variations in IPT initiation among regions signals different dynamics affecting IPT uptake in different regions and hence customized approaches in quality improvement. Implementation research is needed to understand health system as well as cultural barriers in the uptake of IPT intervention.

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Determinants of Isoniazid Preventive Therapy Completion among People Living with HIV Attended Care and Treatment Clinics from 2013 to 2017 in Dar es Salaam Region,Tanzania. A cross-sectional analytical study

10.21203/rs.2.19464/v2 ◽

2020 ◽

Author(s):

Masanja Robert ◽

Jim Todd ◽

Bernard J Ngowi ◽

Sia Msuya ◽

Angella Ramadhani ◽

...

Keyword(s):

Health Facility ◽

Analytical Study ◽

Preventive Therapy ◽

Dar Es Salaam ◽

People Living With Hiv ◽

Cross Sectional ◽

Cd4 Counts ◽

Factors Associated ◽

Care And Treatment ◽

Living With Hiv

Abstract Background: Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least six months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor completion of IPT, as a suboptimal dose may not protect PLHIV from TB infection. This study determined IPT completion and its determinants among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods: A Cross-sectional analytical study was conducted using secondary analysis of routine data from 58 care and treatment clinics in Dar es Salaam region. The study recruited clients who screened negative for TB symptoms and initiated IPT between January 2013 and June 2017. Modified Poisson regression model with robust standard errors were used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account the health facility random effects in order to estimate independent factors associated with IPT completion. Results : A total of 29,382 clients were initiated on IPT, with 21,808 (74%) female. Overall 17,092 (58%) completed IPT, increasing from 42% (773/1,857) in year 2013 to 76% (2,929/3,856) in 2017. Multilevel multivariable model accounting for health facility as clusters, found that clients with CD4 counts between 100 to 349 cells/ had 3% lower prevalence of IPT completion as compared to those with 100 cells/ (PR:0.97: 95%CI:0.94-1.01). Patients who were not on ART had 46% lower IPT completion compared to those were on ART (PR: 0.54: 95%CI: 0.45-0.64). There was lower IPT completion among clients who transferred to another clinic compared to those attended the same clinic where they were initiated IPT (PR: 0.63: 95% CI (0.54-0.74). Conclusion: IPT completion is low at care and treatment clinics although it increased over time. Lower IPT completion was seen in PLHIV with CD4 counts between 100 to 349 cells/ , those who transferred to other clinics and those not on ART. Thus it indicates the need for better IPT interventions with greater support PLHIV in those groups.

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Implementation of isoniazid preventive therapy in people living with HIV in Zambia: challenges and lessons

BMC Public Health ◽

10.1186/s12889-019-7652-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Mary Kagujje ◽

Muhau L. Mubiana ◽

Eugenia Mwamba ◽

Monde Muyoyeta

Keyword(s):

Scale Up ◽

Monitoring And Evaluation ◽

Preventive Therapy ◽

Isoniazid Preventive Therapy ◽

People Living With Hiv ◽

Management Level ◽

Demand Creation ◽

Incidence And Mortality ◽

Latent Tb Infection ◽

Living With Hiv

Abstract Background Uptake of Isoniazid Preventive Therapy (IPT) among People Living with HIV in Zambia has continued to be low despite various evidence for its added benefit in reducing TB incidence and mortality when taken with antiretroviral therapy. In 2017, only 18% of People Living with HIV newly enrolled in care were initiated on IPT in Zambia. Main text Various challenges including policy and management level factors, supply chain factors, health worker perceptions about IPT, monitoring and evaluation factors and limited demand creation activities have constrained the scale up of IPT in Zambia. Lessons that have been learnt while addressing the above challenges are shared and they can be applied by government ministries, project managers, public health specialists to strengthen IPT activities in their settings. Conclusion Zambia has both a high burden of TB and HIV and without preventing new cases of TB from reactivation of latent TB infection, it will be difficult to control TB. All stakeholders involved in prevention of TB among PLHIV need to commit to addressing the challenges limiting scale up of IPT.

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