Scale-up of isoniazid preventive therapy in PEPFAR-assisted clinical sites in South Africa [Notes from the field]

Abstract

We reviewed the implementation of isoniazid preventive therapy (IPT) in South Africa from January 2010 to March 2011. The South African National Department of Health distributed revised IPT guidelines in May 2010 to increase IPT use in eligible human immunodeficiency virus (HIV) infected patients. We found a dramatic increase in the absolute numbers of patients reported to have been initiated on IPT (from 3309 in January-March 2010 to 49 130 in January-March 2011), representing an increase in the proportion (1.0-10.5%) of potentially eligible HIV-infected patients started on IPT.

Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection

“…An analysis of the uptake of preventive therapy in 150 clinical sites in South Africa suggested an increase in the absolute numbers of individuals prescribed preventive therapy (from 3,309 in 2010 to 49,130 in 2011) but a decrease in the proportion of patients receiving it (from 19% in 2010 to 11% in 2011). 50 Although encouraging, a reported surge in recipients is an insufficient indicator of successful implementation. 51 Indicators such as increases in coverage, completion rates, rates of adverse events, and active tuberculosis among those receiving preventive therapy are needed to demonstrate intervention fidelity.…”

Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control

“…Uptake of IPT was poor after introduction of these guidelines, largely due to TST creating a programmatic barrier to implementation and concerns of generating isoniazid resistance. [16] In 2010, in line with the WHO recommendations, SA revised its national IPT guidelines and removed TST as a requirement to initiate IPT, to facilitate programmatic implementation of IPT. The uptake of IPT increased dramatically and more than 375 000 South Africans living with HIV were started on IPT in 2011 and 2012, respectively, making the IPT programme one of the largest in the world.…”

Preventing Tuberculosis Among HIV-Infected Pregnant Women in Lesotho

“…Although it is possible that women did not accept the offer to initiate IPT, it is also feasible that this subset of women was not offered IPT by the health workers, especially during stock out of drugs as reported in previous studies among general adult population. [19][20][21] Further studies including process analyses are warranted to identify reasons for not providing IPT to eligible HIV-positive pregnant women, and to identify interventions that could address structural and behavioral impediments to successful implementation of IPT.…”