Evaluation of the isoniazid preventive therapy (IPT) program in Shurugwi District, Midlands Province, Zimbabwe, January 2013 to August 2014

Abstract

BackgroundMidlands Province started implementing the Isoniazid (INH) preventive therapy (IPT) program in January 2013. Shurugwi and Gokwe North were the piloting district hospitals. In May 2014, four more districts hospitals (Gokwe South, Gweru, Kwekwe and Zvishavane) started implementing IPT. Shurugwi District decentralized the program to its rural health facilities in January 2014. A review of the Shurugwi IPT program, 2013 data, indicated that the majority of eligible clients were not started on IPT. None out of the 400 eligible clients were started on IPT in November against the 100 % target according to the World Health Organization and the National Tuberculosis (TB) Program. We conducted a study to evaluate the IPT program in Shurugwi District from January 2013 to August 2014.MethodsThe logical framework approach was used to evaluate inputs, processes, outputs and outcomes of the IPT program. An interviewer administered questionnaire was used to collect data from key informants. Checklists were used to collect data from IPT program records.ResultsSixteen health facilities were implementing IPT in Shurugwi District. All the facilities had TB screening tools and three did not have TB screening algorithms. The district experienced medicine stock outs in 2013. One formal training at district level and on job trainings in implementing health facilities were done. From January 2013 to August 2014, Shurugwi District screened 6794 antiretroviral (ART) clients for TB. Out of those screened, 5255 were eligible for IPT and 2831 (54 %) were started on IPT. A total of 700 clients had completed the IPT 6 month’s course by August 2014. The dropout rate due to INH toxicity and TB was 0.6 % (n = 18) and 0.3 % (n = 8) respectively. Fifty-three advocacy and community sensitization meetings were done. The program had no Information Education and Communication (IEC) materials.ConclusionThe IPT program in Shurugwi District achieved half its target. This could be due to inadequate formally trained staff, lack of IEC materials, inadequate advocacy and community sensitization, non-availability of the INH 300 mg single dose and inadequate INH 100 mg dose tablets in 2013. To improve the IPT program, there is need for routine advocacy, communication and social mobilization.

Isoniazid preventive therapy: Uptake, incidence of tuberculosis and survival among people living with HIV in Bulawayo, Zimbabwe

“…Second, only about half of the IPT eligible PLHIV were initiated on IPT. This is within the range that has been found in other studies in Africa from 2014–2017 [15,24,25]. Our study results also showed that PLHIV who were separated or divorced were more likely to be initiated on IPT.…”

Implementation of isoniazid preventive therapy among people living with HIV in Northwestern Nigeria: Completion rate and predictive factors

“…IPT completion rate appears to vary across settings, subpopulations, country policy guidelines on duration of treatment, availability of incentives, and whether IPT is provided alone or prepackaged with ART. For instance, studies from Zambia, Kenya, and Ethiopia concluded that under programmatic implementation, combination of IPT with additional package of interventions such as incentives for patient travel reimbursement, training of health-care workers, provision of Information, Education and Communication (IEC) materials and Standard Operating Procedure (SOPs), quality adherence counseling by physicians, patient follow-up, and continuous quality improvement have higher completion rate,[ 3 10 11 12 13 ] compared with implementation not combined with the above package of interventions. [ 14 ]…”

Inequality in uptake of isoniazid prevention therapy and Mantoux test among pregnant women with HIV in the Eastern Cape, South Africa

“…In order for South Africa to reduce the incidence of TB from 9800 per million in 2010 to 1500 per million in 2050 and TB-associated mortality from 2180 per million in 2010 to 200 per million in 2050, IPT must be scaled up to 75% by 2035 [32]. Many other studies across Africa reported rates ranging from 54% in a health district of Zimbabwe [33] to 77% in an urban health centres of Kenya [34]. The recorded low uptakes, irrespective of the geographical settings, have been linked to patients’ related factors such as non-adherence, non-disclosure of HIV serostatus and lack of social support [35, 36] and health care related factors such as the levels of knowledge of the health care providers, and facilities being out of stock, amongst others [33, 37].…”