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

Abstract

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.

Adherence and Associated Factors of Treatment Regimen in Drug-Susceptible Tuberculosis Patients

“…Although several factors such as socioeconomic factors, regimen complexity, long duration of treatment, and pattern of health care delivery system are known to affect adherence to TB drugs, the extent to which additional factor affects TB adherence needs to be explored ( WHO, 2003 ). Past studies evaluating the adherence either focused on highly specific patient population, for instance, those with acquired immune deficiency syndrome ( Shayo et al, 2015 ; Dhungana et al, 2019 ), or based on local registry data with limited sample size and lack of medical history of the individual patient ( Mok et al, 2018 ). Therefore, we sought to assess the adherence to TB drugs and factors affecting adherence among TB patients in South Korea by using a nationwide claims database from 2017 to 2018.…”

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)…”

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

“…Visits corresponding to being in care for more than one year had higher odds of IPT initiation than earlier visits. IPT initiation later after HIV care enrolment is also reported in Nepal (24). Lower IPT initiation associated with Iringa compared to Dar es Salaam and Njombe explains dynamics in IPT implementation which also differs from health facility to health facility as reported in another study (24).…”

“…IPT initiation later after HIV care enrolment is also reported in Nepal (24). Lower IPT initiation associated with Iringa compared to Dar es Salaam and Njombe explains dynamics in IPT implementation which also differs from health facility to health facility as reported in another study (24). Lower IPT initiation in visits with good adherence is contrary to what is expected in normal program settings as good ARV adherence was one of the criteria for IPT initiation.…”