Evaluation of the Isoniazid Preventive Therapy Care Cascade Among HIV-Positive Female Sex Workers in Mombasa, Kenya

Abstract

Background Kenyan female sex workers (FSWs) have a high HIV prevalence, increasing their tuberculosis (TB) risk. Despite recommendations that HIV-positive individuals be offered isoniazid preventive therapy (IPT), uptake has been limited. Methods In this longitudinal cohort of HIV-positive FSWs, we retrospectively characterized the IPT care cascade between March 2000–January 2010, including reasons for cascade loss or appropriate exit. Cascade success required completion of 6 months of IPT. Baseline characteristics were assessed as potential correlates of cascade losses using multivariable logistic regression. Results Among 642 HIV-positive FSWs eligible for IPT evaluation, median age was 31 years (IQR 26–35) with median CD4 lymphocyte count of 409 (IQR 292–604) cells/mm3. There were 249 (39%) women who successfully completed 6 months of IPT, 157 (24%) appropriately exited the cascade, and 236 (37%) were cascade losses. Most cascade losses occurred at symptom screen (38%, 90/236), CXR evaluation (28%, 66/236), or during IPT treatment (30%, 71/236). Twenty-nine women were diagnosed with TB, including one after IPT initiation. Most women initiating IPT completed the course (71%, 249/351); <5% had medication intolerance. Younger women (<25 and 25–35 vs. >35 years; adjusted odds ratio [AOR] 2.65, 95% confidence interval [CI] 1.46–4.80 and AOR 1.78, 95% CI 1.13–2.80, respectively), and those evaluated for IPT after antiretroviral availability in 2004 (AOR 1.92, 95%CI 1.31–2.81), were more likely to be cascade losses. Conclusions Implementation of IPT among HIV-positive FSWs in Kenya is feasible. However, significant losses along the IPT care cascade underscore the need for strategies improving retention in care.

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

“…HIV patients with high CD4 counts ≥350 cells/µL had lower prevalence of IPT completion compared with those with CD4 counts <100 cells/µL. This is consistent with studies in Kenya and Brazil (30,37). Possibly patients with high CD4 counts perceive themselves healthy and not at risk of progressing to active TB, so they stop taking IPT before completing the full treatment course of six months.…”

“…WHO recommends the completion of at least six months IPT for the successful prevention of active tuberculosis among PLHIV (4,10). Globally, six-month IPT completion has been reported to range from 39-99% (28)(29)(30)(31)(32)(33)(34)(35)(36)(37), and in Tanzania studies reported 65%-98% of those who initiated IPT, completed the six month treatment course (6,20,(38)(39)(40). Most epidemiological studies have shown that IPT completion reduces the risks of mortality among PLHIV (8,26,41), decreases the need for expensive TB treatment needs and lowers the cost of HIV services.…”

Outcomes of isoniazid preventive therapy among people living with HIV in Kenya: A retrospective study of routine health care data

“…Though our study was focusing on only those on ART, we do not think this differs much as the country's policy has been the initiation of IPT regardless of ART status. Kenya adopted routine TB screening for PLHIV at every clinic visit by use of the ICF tool in 2011 [20,25] to accommodate for pediatrics and Adults. This has recently been reinforced…”

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

“…WHO recommends the completion of at least six months IPT for the successful prevention of active tuberculosis among PLHIV (4,10). Globally, six-month IPT completion has been reported to range from 39-99% (28)(29)(30)(31)(32)(33)(34)(35)(36)(37), and in Tanzania studies reported 65%-98% of those who initiated IPT, completed the six month treatment course (6,20,(38)(39)(40). Most epidemiological studies have shown that IPT completion reduces the risks of mortality among PLHIV (8,26,41)…”