scholarly journals Successful implementation of isoniazid preventive therapy at a pediatric HIV clinic in Tanzania

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Olivia F. Hunter ◽  
Furaha Kyesi ◽  
Amrit Kaur Ahluwalia ◽  
Zeinabou Niamé Daffé ◽  
Patricia Munseri ◽  
...  
Keyword(s):  
Treatment Completion ◽  
Preventive Therapy ◽  
Pediatric Hiv ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
Successful Implementation ◽  
Completion Rates ◽  
Community Based ◽  
Symptom Screening ◽  
Living With Hiv

Abstract Background In accordance with international guidance for tuberculosis (TB) prevention, the Tanzanian Ministry of Health recommends isoniazid preventive therapy (IPT) for children aged 12 months and older who are living with HIV. Concerns about tolerability, adherence, and potential mistreatment of undiagnosed TB with monotherapy have limited uptake of IPT globally, especially among children, in whom diagnostic confirmation is challenging. We assessed IPT implementation and adherence at a pediatric HIV clinic in Tanzania. Methods In this prospective cohort study, eligible children living with HIV aged 1–15 years receiving care at the DarDar Pediatric Program in Dar es Salaam who screened negative for TB disease were offered a 6-month regimen of daily isoniazid. Patients could choose to receive IPT via facility- or community-based care. Parents/caregivers and children provided informed consent and verbal assent respectively. Isoniazid was dispensed with the child’s antiretroviral therapy every 1–3 months. IPT adherence and treatment completion was determined by pill counts, appointment attendance, and self-report. Patients underwent TB symptom screening at every visit. Results We enrolled 66 children between July and December 2017. No patients/caregivers declined IPT. Most participants were female (n = 43, 65.1%) and the median age was 11 years (interquartile range [IQR] 8, 13). 63 (95.5%) participants chose the facility-based model; due to the small number of participants who chose the community-based model, valid comparisons between the two groups could not be made. Forty-nine participants (74.2%) completed IPT within 10 months. Among the remaining 17, 11 had IPT discontinued by their provider due to adverse drug reactions, 5 lacked documentation of completion, and 1 had unknown outcomes due to missing paperwork. Of those who completed IPT, the average monthly adherence was 98.0%. None of the participants were diagnosed with TB while taking IPT or during a median of 4 months of follow-up. Conclusions High adherence and treatment completion rates can be achieved when IPT is integrated into routine, self-selected facility-based pediatric HIV care. Improved record-keeping may yield even higher completion rates. IPT was well tolerated and no cases of TB were detected. IPT for children living with HIV is feasible and should be implemented throughout Tanzania.

scholarly journals Successful Implementation of Isoniazid Preventive Therapy at a Pediatric HIV Clinic in Tanzania

2019 ◽  
Author(s):  
Olivia Hunter ◽  
Furaha Kyesi ◽  
Amrit Ahluwalia ◽  
Zeinabou Niamé Daffé ◽  
Patricia Munseri ◽  
...  
Keyword(s):  
Treatment Completion ◽  
Preventive Therapy ◽  
Pediatric Hiv ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
Successful Implementation ◽  
Completion Rates ◽  
Community Based ◽  
Symptom Screening ◽  
Living With Hiv

Abstract Background: In accordance with international guidance for tuberculosis (TB) prevention, the Tanzanian Ministry of Health recommends isoniazid preventive therapy (IPT) for children aged 12 months and older who are living with HIV. Concerns about tolerability, adherence, and potential mistreatment of undiagnosed TB with monotherapy have limited uptake of IPT globally, especially among children, in whom diagnostic confirmation is challenging. We assessed pediatric IPT implementation and adherence at a pediatric HIV clinic in Tanzania. Methods: Eligible HIV-infected children aged 1-15 years receiving care at the DarDar Pediatric Program in Dar es Salaam who screened negative for TB disease signs and symptoms were offered a 6-month regimen of daily isoniazid. Patients could choose to receive their IPT via facility- or community-based care. Isoniazid was dispensed with the child’s antiretroviral therapy every 1-3 months. IPT adherence and treatment completion was determined by pill counts, appointment attendance, and self-report. Patients underwent TB symptom screening at every visit. Results: We enrolled 66 children between July and December 2017. No patients/caregivers declined IPT. Most participants were female (n=43, 65.1%) and the median age was 11 years (interquartile range [IQR] 8, 13). 63 (95.5%) participants chose the facility-based model; due to the small number of participants who chose the community-based model, valid comparisons between the two groups could not be made. Forty-nine participants (74.2%) completed IPT within 10 months. Among the remaining 17, most (n=11, 64.7%) had IPT discontinued by their provider due to adverse drug reactions; 5 patients (29.4%) lacked documentation of completion. Of those who completed IPT, the average monthly adherence was 98.0%. None of the participants were diagnosed with TB while taking IPT or during a median of 4 months of follow-up. Conclusions: High adherence and treatment completion rates can be achieved when IPT is integrated into routine, self-selected facility-based pediatric HIV care. Improved record-keeping may yield even higher completion rates. IPT was well tolerated and no cases of TB were detected. IPT for children living with HIV is feasible and should be implemented throughout Tanzania and in similar high TB/HIV-burden settings.

scholarly journals Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e029058 ◽  
Author(s):  
Govinda Prasad Dhungana ◽  
Pruthu Thekkur ◽  
Palanivel Chinnakali ◽  
Usha Bhatta ◽  
Basudev Pandey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Western Region ◽  
Completion Rates ◽  
Living With Hiv

ObjectivesIsoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal.DesignWe conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres.SettingAll 11 ART centres in the FWR of Nepal.ParticipantsAll PLHIV registered for care between January 2016 and December 2017 in 11 ART centres.Primary outcome measuresIPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated.ResultOf the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation.ConclusionsIn FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap.

scholarly journals Impact of Isoniazid Preventive Therapy on Tuberculosis incidence among people living with HIV: A secondary data analysis using Inverse Probability Weighting of individuals attending HIV care and treatment clinics in Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254082
Author(s):  
Werner M. Maokola ◽  
Bernard J. Ngowi ◽  
Michael J. Mahande ◽  
Jim Todd ◽  
Masanja Robert ◽  
...  
Keyword(s):  
Observational Studies ◽  
Cox Regression ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Clinical Settings ◽  
Inverse Probability ◽  
Care And Treatment ◽  
Living With Hiv

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.

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

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.

Isoniazid preventive therapy use among adult people living with HIV in Zimbabwe

2021 ◽  
pp. 095646242110144
Author(s):  
Mayuko Takamiya ◽  
Kudawashe Takarinda ◽  
Shrish Balachandra ◽  
Musuka Godfrey ◽  
Elizabeth Radin ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Scale Up ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hazardous Alcohol Use ◽  
Factors Associated ◽  
Hazardous Alcohol ◽  
Living With Hiv

We assessed the prevalence of isoniazid preventive therapy (IPT) uptake and explored factors associated with IPT non-uptake among people living with HIV (PLHIV) using nationally representative data from the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) 2015–2016. This was a cross-sectional study of 3418 PLHIV ZIMPHIA participants eligible for IPT, aged ≥15 years and in HIV care. Logistic regression modeling was performed to assess factors associated with self-reported IPT uptake. All analyses accounted for multistage survey design. IPT uptake among PLHIV was 12.7% (95% confidence interval (CI): 11.4–14.1). After adjusting for sex, age, rural/urban residence, TB screening at the last clinic visit, and hazardous alcohol use, rural residence was the strongest factor associated with IPT non-uptake (adjusted OR (aOR): 2.39, 95% CI: 1.82–3.12). Isoniazid preventive therapy non-uptake having significant associations with no TB screening at the last HIV care (aOR: 2.07, 95% CI: 1.54–2.78) and with hazardous alcohol use only in urban areas (aOR: 10.74, 95% CI: 3.60–32.0) might suggest suboptimal IPT eligibility screening regardless of residence, but more so in rural areas. Self-reported IPT use among PLHIV in Zimbabwe was low, 2 years after beginning national scale-up. This shows the importance of good TB screening procedures for successful IPT implementation.

High completion rates of isoniazid preventive therapy among persons living with HIV in Swaziland

2017 ◽  
Vol 21 (10) ◽  
pp. 1127-1132 ◽  
Author(s):  
L. V. Adams ◽  
N. Mahlalela ◽  
E. A. Talbot ◽  
M. Pasipamire ◽  
S. Ginindza ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Completion Rates ◽  
Persons Living With Hiv ◽  
Living With Hiv

scholarly journals Early-phase scale-up of isoniazid preventive therapy for people living with HIV in two districts in Malawi (2017)

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248115
Author(s):  
Scott A. Nabity ◽  
Laurence J. Gunde ◽  
Diya Surie ◽  
Ray W. Shiraishi ◽  
Hannah L. Kirking ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Urban Areas ◽  
Early Phase ◽  
Scale Up ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
People Living With Hiv ◽  
Initiation Rate ◽  
Symptom Screening ◽  
Living With Hiv

Background Isoniazid preventive therapy (IPT) against tuberculosis (TB) is a life-saving intervention for people living with HIV (PLHIV). In September 2017, Malawi began programmatic scale-up of IPT to eligible PLHIV in five districts with high HIV and TB burden. We measured the frequency and timeliness of early-phase IPT implementation to inform quality-improvement processes. Methods and findings We applied a two-stage cluster design with systematic, probability-proportional-to-size sampling of six U.S. Centers for Disease Control and Prevention (CDC)-affiliated antiretroviral therapy (ART) centers operating in the urban areas of Lilongwe and Blantyre, Malawi (November 2017). ART clinic patient volume determined cluster size. Within each cluster, we sequentially sampled approximately 50 PLHIV newly enrolled in ART care. We described a quality-of-care cascade for intensive TB case finding (ICF) and IPT in PLHIV. PLHIV newly enrolled in ART care were eligibility-screened for hepatitis and peripheral neuropathy, as well as for TB disease using a standardized four-symptom screening tool. Among eligible PLHIV, the overall weighted IPT initiation rate was 70% (95% CI: 46%–86%). Weighted IPT initiation among persons aged <15 years (30% [95% CI: 12%–55%]) was significantly lower than among persons aged ≥15 years (72% [95% CI: 47%–89%]; Rao-Scott chi-square P = 0.03). HIV-positive children aged <5 years had a weighted initiation rate of only 13% (95% CI: 1%–79%). For pregnant women, the weighted initiation rate was 67% (95% CI: 32%–90%), similar to non-pregnant women aged ≥15 years (72% [95% CI: 49%–87%]). Lastly, 95% (95% CI: 92%–97%) of eligible PLHIV started ART within one week of HIV diagnosis, and 92% (95% CI: 73%–98%) of patients receiving IPT began on the same day as ART. Conclusions Early-phase IPT uptake among adults at ART centers in Malawi was high. Child uptake needed improvement. National programs could adapt this framework to evaluate their ICF-IPT care cascades.

scholarly journals Correction to: Successful implementation of isoniazid preventive therapy at a pediatric HIV clinic in Tanzania

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Olivia F. Hunter ◽  
Furaha Kyesi ◽  
Amrit Kaur Ahluwalia ◽  
Zeinabou Niamé Daffé ◽  
Patricia Munseri ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Pediatric Hiv ◽  
Isoniazid Preventive Therapy ◽  
Successful Implementation

An amendment to this paper has been published and can be accessed via the original article.

Provision of Isoniazid Preventive Therapy: The Experiences of People Living with HIV

2020 ◽  
Vol 21 (2) ◽  
Author(s):  
Keamogetse Selehelo ◽  
Lufuno Makhado ◽  
Karabo Angel Madiba
Keyword(s):  
South Africa ◽  
Health Centre ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
World Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
North West ◽  
Retention In Hiv Care ◽  
Living With Hiv

Isoniazid preventive therapy (IPT) is a strategy that has been proposed by the National Department of Health of South Africa and the World Health Organization for people living with HIV (PLWH) to prevent latent tuberculosis (TB) progressing to active TB. This research focused on exploring and describing experiences of PLWH regarding IPT provision in the Ngaka Modiri Molema district in the North West province of South Africa. A qualitative, exploratory, contextual and descriptive research design was used for this study. Semi-structured individual interviews were conducted to collect data from PLWH. The sample size consisted of 14 participants and data saturation was reached at participant 11. A thematic data analysis was employed in this study. The study consisted of 10 female participants and 4 male participants. Three main themes emerged during interviews, namely factors that facilitate IPT provision and uptake, factors that inhibit the adherence of patients to IPT, and strategies to improve provision or adherence. The provision of IPT at a community health centre in Ngaka Modiri Molema district municipality was reported to be satisfactorily although challenges were also marked. IPT must be available at all times to ensure the promotion of PLWH adherence, continuity of care and retention in HIV care. In addition, screening of PLWH for active TB disease before they can be initiated should be a priority. PLWH should be supported and followed up through the directly observed treatment, short-course strategy to promote adherence and this can also be facilitated through adherence social clubs.

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