Can isoniazid preventive therapy be scaled up rapidly? Lessons learned in Kenya, 2014–2018

2021 ◽  
Vol 25 (5) ◽  
pp. 367-372
Author(s):  
H. Weyenga ◽  
M. Karanja ◽  
E. Onyango ◽  
A. K. Katana ◽  
L. W. Ng´ang´a ◽  
...  
Keyword(s):  
Scale Up ◽  
Stakeholder Involvement ◽  
Preventive Therapy ◽  
Hiv Treatment ◽  
Lessons Learned ◽  
Isoniazid Preventive Therapy ◽  
People Living With Hiv ◽  
Cumulative Number ◽  
Program Success ◽  
Lost To Follow Up

BACKGROUND: TB is the leading cause of mortality among people living with HIV (PLHIV), for whom isoniazid preventive therapy (IPT) has a proven mortality benefit. Despite WHO recommendations, countries have been slow in scaling up IPT. This study describes processes, challenges, solutions, outcomes and lessons learned during IPT scale‐up in Kenya.METHODS: We conducted a desk review and analyzed aggregated Ministry of Health (MOH) IPT enrollment data from 2014 to 2018 to determine trends and impact of program activities. We further analyzed IPT completion reports for patients initiated from 2015 to 2017 in 745 MOH sites in Nairobi, Central, Eastern and Western Kenya.RESULTS: IPT was scaled up 75‐fold from 2014 to 2018: the number of PLHIV covered increased from 9,981 to 749,890. The highest percentage increases in the cumulative number of PLHIV on IPT were seen in the quarters following IPT pilot projects in 2014 (49%), national launch in 2015 (54%), and HIV treatment acceleration in 2016 (158%). Among 250,069 patients initiating IPT from 2015 to 2017, 97.5% completed treatment, 0.2% died, 0.8% were lost to follow‐up, 1.0% were not evaluated, and 0.6% discontinued treatment.CONCLUSIONS: IPT can be scaled up rapidly and effectively among PLHIV. Deliberate MOH efforts, strong leadership, service delivery integration, continuous mentorship, stakeholder involvement, and accountability are critical to program success.

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.

scholarly journals Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e034721
Author(s):  
Kudakwashe C Takarinda ◽  
Anthony D Harries ◽  
Tsitsi Mutasa-Apollo ◽  
Charles Sandy ◽  
Regis C Choto ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Scale Up ◽  
Population Level ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
People Living With Hiv ◽  
National Data ◽  
Tuberculosis Case ◽  
Case Notification ◽  
Roll Out

ObjectivesAntiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018.DesignEcological study using aggregate national data.SettingAnnual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT.ResultsART coverage in the public sector increased from <1% (8400 PLHIV) in 2004 to ~88% (>1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001).ConclusionsThis study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage.

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

2019 ◽  
Vol 19 (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.

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.

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 Retention in Care among Patients with Early HIV Disease in Haiti

2017 ◽  
Vol 16 (6) ◽  
pp. 523-526 ◽  
Author(s):  
Kelly A. Hennessey ◽  
Taina Dadaille Leger ◽  
Vanessa R. Rivera ◽  
Adias Marcelin ◽  
Margaret L. McNairy ◽  
...  
Keyword(s):  
Cell Count ◽  
Retention In Care ◽  
Hiv Treatment ◽  
World Health ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Hiv Test ◽  
Lost To Follow Up ◽  
Cd4 Cell

In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.

scholarly journals Factors affecting the acceptability of isoniazid preventive therapy among healthcare providers in selected HIV clinics in Nairobi County, Kenya: a qualitative study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024286 ◽  
Author(s):  
Elvis Omondi Achach Wambiya ◽  
Martin Atela ◽  
Ejemai Eboreime ◽  
Latifat Ibisomi
Keyword(s):  
Qualitative Study ◽  
Healthcare Providers ◽  
Preventive Therapy ◽  
Sub Saharan Africa ◽  
Isoniazid Preventive Therapy ◽  
Public Healthcare ◽  
People Living With Hiv ◽  
Policy Makers ◽  
Factors Affecting ◽  
High Level

ObjectiveDespite being globally recommended as an effective intervention in tuberculosis (TB) prevention among people living with HIV, isoniazid preventive therapy (IPT) implementation remains suboptimal, especially in sub-Saharan Africa. This study explored the factors influencing the acceptability of IPT among healthcare providers in selected HIV clinics in Nairobi County, Kenya, a high HIV/TB burden country.DesignA qualitative study was conducted using in-depth interviews with healthcare providers in selected HIV clinics. All conversations were audio recorded, transcribed verbatim and analysed using a thematic approach.SettingThe study was conducted in the HIV clinics of three purposefully selected public healthcare facilities in Nairobi County, Kenya between February 2017 and April 2017.ParticipantsEighteen purposefully selected healthcare providers (clinicians, nurses, pharmacists and counsellors) working in the HIV clinics participated in the study.ResultsProvider acceptability of IPT was influenced by factors relating to the organisational context, provider training on IPT and their perception on its efficacy, length and clarity of IPT guidelines and standard operation procedures, as well as structural factors (policy, physical and work environment). Inadequate high-level commitment and support for the IPT programme by programme managers and policy-makers were found to be the major barriers to successful IPT implementation in our study context.ConclusionThis study provides insight into the complexity of factors affecting the IPT implementation in Kenya. Ensuring optimal acceptability of IPT among healthcare providers will require an expanded depth of engagement by policy-makers and IPT programme managers with both providers and patients, as well as on-the-job design specific actions to support providers in implementation. Such high-level commitment and support are consequently essential for quality delivery of the intervention.

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