Loss to follow up from isoniazid preventive therapy among adults attending HIV voluntary counseling and testing sites in Uganda

Namuwenge, Proscovia M; Mukonzo, Jackson; Kiwanuka, Noah; Wanyenze, Rhoda K.; Byaruhanga, Raymond; Bissell, Karen; Zachariah, Rony

doi:10.1016/j.trstmh.2011.10.015

Cited by 22 publications

(32 citation statements)

References 15 publications

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“…This completion rate is lower than those observed in eastern Kenya 13 and Tanzania, 14,15 but higher than in Uganda 8 and Botswana. 9 Among the patients who did not complete IPT, a large number were lost to follow-up, and many received only the first month's supply of IPT.…”

Section: Discussioncontrasting

confidence: 62%

“…Health-care workers from the respective health institutions were trained in ICF and IPT monitoring and evaluation and medicine management skills in preparation for the pilot, and post-training support and mentorship were offered. While a full course of IPT has been shown to reduce the risk of TB in PLHIV, its uptake has generally been poor, with concerns about the treatment completion rates being reported in Uganda 8 and Botswana. 9 To inform the Ministry of Health about the feasibility of continued scale-up of IPT to other public ART clinics countrywide, we sought to determine, among PLHIV commenced on IPT, 1) the completion rates for a full course of IPT, and 2) factors associated with non-completion of IPT.…”

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confidence: 99%

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Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Takarinda

Choto

Harries

et al. 2017

public health action

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Setting: Seven pilot sites in Zimbabwe implementing 6 months of isoniazid preventive therapy (IPT) for people living with the human immunodeficiency virus (PLHIV). Objectives: To determine, among PLHIV started on IPT, the completion rates for a 6-month course of IPT and factors associated with non-adherence. Design: A retrospective cohort study. Results: Of 578 patients, 466 (81%) completed IPT. Of the 112 patients who failed to complete IPT, 69 (60%) were lost to follow-up, 30 (27%) stopped treatment with no documented reasons, 8 (7%) developed toxicity/adverse reactions, 5 (5%) were documented as having drug stock-outs and the remainder transferred out or refused to continue treatment. Currently being on antiretroviral therapy (ART) (aOR 0.09, 95%CI 0.03-0.28) and receiving a 2 month supply of isoniazid at the start of treatment were associated with a lower risk of not completing IPT, while missing clinic visits prior to starting IPT (aOR 5.25, 95%CI 2.10-13.14) was associated with a higher risk of non-completion. Conclusion: IPT completion rates in seven pilot sites of Zimbabwe were comparatively high, showing that IPT roll-out in public health facilities is feasible. Enhanced adherence counselling or active tracing among pre-ART patients and those with a history of loss to follow-up may improve IPT completion rates, along with synchronising IPT and ART resupplies. Public Health Action IPT in Zimbabwe 56the WHO-recommended four-symptom TB screening checklist. 11 If PLHIV present with any of the four symptoms, they are considered to be presumptive TB cases and sputum specimens are collected for smear microscopy or Xpert ® MTB/RIF (Cepheid, Sunnyvale, CA, USA) testing. Those patients negative on Xpert or smear microscopy and who have no other symptoms or signs of extra-pulmonary or smear-negative pulmonary TB, including chest radiography if necessary, are not recorded as having active TB. During the pilot phase, PLHIV who were not diagnosed with active TB were offered adherence counselling and were started on a daily oral dose of isoniazid (INH, 5 mg/kg body weight for adults or 10 mg/kg body weight for children) plus a daily low dose of pyridoxine (25 mg/day) for a 6-month period, regardless of their ART status. It was recommended that patients receive regular supplies of INH every month until completion of their prophylactic treatment. 10 During clinic visits, patients were assessed through self-reporting and pill counts for adherence and screened for TB. Patients found to have active TB were taken off IPT and treated according to the national TB guidelines. 11 Data on TB status (screened with no TB signs/not screened/ presumptive TB case/active TB), IPT status (yes/no), IPT quantity dispensed and reasons for starting or stopping IPT were integrated into the individual patient opportunistic infection (OI) ART care booklets and the pre-ART or ART registers, depending on the patients' ART status. This information was updated during each clinical review visit. For easier tracing of all clients enrolled on IPT, ...

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Section: Discussioncontrasting

confidence: 62%

mentioning

confidence: 99%

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Takarinda

Choto

Harries

et al. 2017

public health action

View full text Add to dashboard Cite

show abstract

“…Even though available evidence suggests that the effect of IPT scale-up on isoniazid resistance is likely to be small [35], limited ability to definitively exclude active TB with available TB diagnostic tests (e.g. smear microscopy) and limited ability to monitor and ensure IPT adherence in a resource-constrained environment [36], may have hindered widespread IPT use [4]. Because both TB screening and IPT prescription for eligible patients at ART enrollment are important morbidity reduction and infection control interventions [37], uptake of these services should be monitored to assess continued improvement over time.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Determinants of Tuberculosis among Adults Initiating Antiretroviral Therapy – Mozambique, 2004–2008

et al. 2013

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BackgroundIn Mozambique, tuberculosis (TB) is thought to be the most common cause of death among antiretroviral therapy (ART) enrollees. Monitoring proportions of enrollees screened for TB, and incidence and determinants of TB during ART can help clinicians and program managers identify program improvement opportunities.Methodology/Principal FindingsWe conducted a retrospective cohort study among a nationally representative sample of the 79,500 adults (>14 years old) initiating ART during 2004–2007 to estimate clinician compliance with TB screening guidelines, factors associated with active TB at ART initiation, and incidence and predictors of documented TB during ART follow-up. Of 94 sites enrolling >50 adults on ART, 30 were selected using probability-proportional-to-size sampling; 2,596 medical records at these sites were randomly selected for abstraction and analysis. At ART initiation, median age of patients was 34, 62% were female, median baseline CD4+ T-cell count was 153/µL, and 11% were taking TB treatment. Proportions of records with TB screening documentation before ART initiation improved from 31% to 66% during 2004–2007 (p<0.001). TB screening compliance varied widely by ART clinic [n = 30, 2%–98% (p<0.001)] and supporting non-Governmental Organization (NGO) [n = 7, 27%–83% (p<0.001)]. Receiving TB treatment at ART enrollment was associated with male sex (p<0.001), weight <45 kg (p<0.001) and CD4<50/µL (p = 0.001). Isoniazid preventive therapy (IPT) was prescribed to <1% of ART enrollees not taking TB treatment. TB incidence during ART was 2.32 cases per 100 person-years. Factors associated with TB incidence included adherence to ART <95% (AHR 2.06; 95% CI, 1.32–3.21).ConclusionVariations in TB screening by clinic and NGO may reflect differing investments in TB screening activities. Future scale-up should target under-performing clinics. Scale-up of TB screening at ART initiation, IPT, and ART adherence interventions could significantly reduce incident TB during ART.

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“…The significance of risk factors of LTFU (i.e. patient demographics, socioeconomic status, directly observed treatment, short-course (DOTS) programme, clinical covariates, TB treatment regimen and HIV co-infection) on LTFU have been contested across countries [10,14,15,[18][19][20][21][22][23][24]. In Namibia, despite universal coverage of high-quality DOTS, little is known about the impact of these factors on poor treatment outcomes and, in particular, LTFU, hence, the current study intended to determine the prevalence and determinants of LTFU in the Namibian context.…”

Section: Introductionmentioning

confidence: 99%

Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia

et al. 2020

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BackgroundIn Namibia, one out of every 25 cases of tuberculosis (TB) is “lost to follow-up” (LTFU). This has impacted negatively on national efforts to end the disease by 2035. The aim of this study was to determine the trends and predictors of LTFU under the directly observed treatment short-course (DOTS) programme in Namibia.MethodsThe study involved a retrospective longitudinal analysis of a nationwide cohort of TB cases registered under the DOTS programme in Namibia from 2006 to 2015. The trends and predictors of LTFU among cases in the National Electronic TB Register of the National TB and Leprosy Program were respectively determined by interrupted time series and multivariate logistic regression analyses using R-Studio software.ResultsOut of 104 203 TB cases, 3775 (3.6%) were LTFU. A quarter (26%) of cases with poor outcomes were due to LTFU. The annual decline in cases of LTFU was significant between the first (2005–2010) and second (2010–2015) medium-term plan period for TB programme implementation (p=0.002). The independent predictors of LTFU were male sex (p=0.004), 15–24 years age group (p=0.03), provider of treatment (p<0.001), intensive phase (p=0.047) and living in border/transit regions (p<0.001). HIV co-infection and TB regimen were not significant predictors of LTFU.ConclusionsThere were declining trends in LTFU in Namibia. DOTS programmes should integrate socioeconomic interventions for young and middle-aged adult male TB cases to reduce LTFU.

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Loss to follow up from isoniazid preventive therapy among adults attending HIV voluntary counseling and testing sites in Uganda

Cited by 22 publications

References 15 publications

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Incidence and Determinants of Tuberculosis among Adults Initiating Antiretroviral Therapy – Mozambique, 2004–2008

Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia

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