Determinants of isoniazid preventive therapy completion among people living with HIV attending care and treatment clinics from 2013 to 2017 in Dar es Salaam Region, Tanzania. A cross-sectional analytical study

Abstract

Background Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least 6 months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor the six-month IPT completion since a suboptimal dose may not protect PLHIV from TB infection. This study determined the six-month IPT completion and factors associated with six-month IPT completion among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods Secondary analysis of routine data from PLHIV attending 58 care and treatment clinics in Dar es Salaam region was used. PLHIV, aged 15 years and above, who screened negative for TB symptoms and initiated IPT from January, 2013 to June, 2017 were recruited. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account for health facility random effects in order to estimate adjusted PR (APR) for factors associated with IPT six-month completion. Results A total of 29,382 PLHIV were initiated IPT, with 21,808 (74%) female. Overall 17,092 (58%) six-month IPT completion, increasing from 42% (773/1857) in year 2013 to 76% (2929/3856) in 2017. Multilevel multivariable model accounting for health facilities as clusters, showed PLHIV who were not on ART had 46% lower IPT completion compared to those were on ART (APR: 0.54: 95%CI: 0.45–0.64). There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54–0.74) compared to those who did not transfer. PLHIV aged 25–34 years had a 6% lower prevalence of IPT completion as compared to those aged 15 to 24 years (APR:0.94 95%CI:0.89–0.98). Conclusion The IPT completion rate in PLHIV increased over time, but there was lower IPT completion in PLHIV who transferred from other clinics, who were aged 25 to 34 years and those not on ART. Interventions to support IPT in these groups are urgently needed.

Isoniazid preventive therapy completion and factors associated with non-completion among patients on antiretroviral therapy at Kisenyi Health Centre IV, Kampala, Uganda

“…In this case, the transfer-in facility may not offer care continuity (in this case INH) due to a lack of relevant documentation from the transfer-out facility (64). This finding is similar to a study done in Dar es salaam where people living with HIV who were transferred to other clinics within Dar es Salaam region after IPT initiation had significantly lower IPT completion levels compared to those that attended the same clinic (57). These findings are also similar to studies conducted in Zimbabwe and Ethiopia (26, 65).…”

“…Distance to the health facility was cited as one of the barriers to IPT completion as patients could not afford transport every month to the health facility to pick up their IPT doses. This echoes findings from studies conducted in Tanzania, Zimbabwe, and Ethiopia which found that patients were discouraged by the need to attend clinic every month combined with the long treatment duration of IPT (26, 56, 57). A significant proportion of patients do not get ART from their nearest facility (58, 59) due to various reasons that include the fear of stigma, and the perception that care at local facilities being of lower quality compared to distant ones (59, 60).…”

Evaluation of the uptake of tuberculosis preventative therapy for people living with HIV in Namibia: a multiple methods analysis

“…Similar barriers identified in this study have been identified in TPT evaluations completed in other countries in Africa, including the lack of services and medication availability, provider concern about promoting drug resistance, lack of clarity about appropriate candidates, and viewing TPT as a low priority among competing healthcare needs. Additionally, recent analyses in South Africa/Uganda, Zimbabwe and Tanzania described TPT cascade completion rates between 15 and 49%, similar to what was observed in in Namibia [36][37][38].…”

Increased uptake of tuberculosis preventive therapy (TPT) among people living with HIV following the 100-days accelerated campaign: A retrospective review of routinely collected data at six urban public health facilities in Uganda

“…We observed that patients not on ART or newly initiated on ART were associated with low IPT completion before 2019 compared to their ART experienced counterparts. Similarly, some previous studies found that TPT completion was associated with being on ART (7,29). Patients who are new or not on ART are likely to have stigma (30,31), poor adherence (32), and lack of understanding of the role of TB prevention in the absence of symptoms (33).…”