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Tuwa A, Okia D, Nantale R, Jaka H, Alunyo JP, Mukunya D, Matovu JK, Kibuule D. Factors associated with uptake of isoniazid preventive therapy among children living with HIV in Mwanza region, Tanzania: a cross-sectional study. BMC Public Health 2024; 24:2221. [PMID: 39148019 PMCID: PMC11325747 DOI: 10.1186/s12889-024-19705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/06/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading cause of death among children living with HIV (CLHIV). Isoniazid preventive therapy (IPT) reduces the incidence of TB by 70% and mortality by 50% among CLHIV. However, in most developing countries including Tanzania, the uptake of IPT is suboptimal, below the 90% WHO-global uptake target. We assessed the factors associated with IPT uptake among CLHIV in Mwanza region, Tanzania. METHODS This was a multicenter facility-based cross-sectional study among CLHIV aged 1 to 10 years in seven districts of Mwanza region, Tanzania from 1st November 2021 to 20th January 2022. Data were collected using a structured interview-administered questionnaire including information on children and caregivers' demographics, caregivers' health related information and children's clinical information. Our outcome variable was uptake of IPT, defined as initiation on IPT either during the time of the study or within past three years before this study We conducted modified Poisson regression to assess the association between IPT uptake and selected exposures in Stata version 15.0. RESULTS A total of 415 CLHIV were enrolled, the median age of the children was 7 years (Interquartile range: 5-8). The uptake of IPT was 91% (n = 377). The majority of children's caregivers were HIV positive (86%, n = 387) and were aware about IPT (63.6%, n = 264). Factors associated with IPT uptake included; having an employed caregiver [Adjusted Prevalence Ratio (aPR): 1.06 95% Confidence Interval (CI): 1.00-1.13] and attending the ART clinic every month [aPR: 1.00; 95% CI: 0.87-1.00] . CONCLUSIONS The uptake of IPT uptake among CLHIV in Mwanza, Tanzania exceeds the global WHO-target of ≥ 90%. Monthly ART clinic visits could be essential in promoting IPT uptake among CLHIV.
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Affiliation(s)
- Ally Tuwa
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Community and Research, Mwanza College of Health and Allied Sciences- MWACHAS, P.O.BOX 476, Mwanza, Tanzania
| | - David Okia
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
| | - Hyasinta Jaka
- Department of Community and Research, Mwanza College of Health and Allied Sciences- MWACHAS, P.O.BOX 476, Mwanza, Tanzania
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Catholic University of Health and Allied Sciences-CUHAS, P.O.BOX 1464, Bugando, Mwanza, Tanzania
- Community Health and Development Foundation-CHADF, P.O.BOX 476, Buyombe, Ilemela, Mwanza, Tanzania
| | - Jimmy Patrick Alunyo
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Joseph Kb Matovu
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology and Therapeutics, Busitema University Faculty of Health Sciences, Mbale, Uganda
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Olajide OS, Okonkwo P, Ajayi O, Adetoye D, Ogunsola OO, Ogundele O, Elujide O, Adurogbola F, Jwanle P. Predictors of tuberculosis treatment outcomes among people living with HIV in some States in Nigeria. Pan Afr Med J 2024; 47:149. [PMID: 38933432 PMCID: PMC11204984 DOI: 10.11604/pamj.2024.47.149.35719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/08/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health threats globally and worse when they co-exist in susceptible individuals. The study examined TB treatment outcomes and their predictive factors among people living with HIV (PLHIVs). Methods a review of TB/HIV co-infected patients who had TB treatments across comprehensive antiretroviral therapy (ART) sites with ≥500 patients was conducted in seven United States of America President's Emergency Plan for AIDS Relief (PEPFAR)-supported States in Nigeria. Data on patient background, HIV and TB care, and TB treatment outcomes were collected using an Excel abstraction template. The data was analyzed using SPSS and an association was examined using a chi-square test while binary logistic regression was used to determine predictors of TB treatment outcomes (P< 0.05). Results two thousand six hundred and fifty-two co-infected patients participated in the study. The mean age of participants was 37 ± 14 years. A majority had TB treatment success (cured = 1059 (39.9%), completed = 1186 (44.7%)). Participants who had pulmonary TB, virally suppressed and commenced isoniazid (INH) before TB diagnosis were more likely to have a favorable TB treatment outcome compared to those who had extrapulmonary TB (AOR = 7.110, 95% CI = 1.506 - 33.565), virally unsuppressed (AOR = 1.677, 95% CI = 1.036 - 2.716) or did not commence INH before TB diagnosis (AOR = 1.486, 95% CI = 1.047 - 2.109). Conclusion site of infection, immune status, exposure to ART, and INH prophylaxis were found to predict TB treatment outcomes among PLHIVs. Stakeholders should ensure early commencement of ART and INH prophylaxis for PLHIVs.
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Affiliation(s)
| | - Prosper Okonkwo
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
| | - Oluseye Ajayi
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
| | | | | | | | - Oluwasogo Elujide
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
| | | | - Plang Jwanle
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
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An Y, Teo AKJ, Huot CY, Tieng S, Khun KE, Pheng SH, Leng C, Deng S, Song N, Nonaka D, Yi S. They do not have symptoms - why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study. BMC Pulm Med 2023; 23:83. [PMID: 36899328 PMCID: PMC10000356 DOI: 10.1186/s12890-023-02379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Latent tuberculosis (TB) infection has been known as a seedbed for TB disease later in life. The interruption from latent TB infection to TB disease can be done through TB preventive treatment (TPT). In Cambodia, only 40.0% of children under five years old who were the household contacts to bacteriologically confirmed TB cases were initiated with TPT in 2021. Scientific studies of context-specific operational challenges in TPT provision and uptake among children are scarce, particularly in high TB-burden countries. This study identified challenges in TPT provision and uptake among children in Cambodia from the perspective of healthcare providers and caregivers. METHODS Between October and December 2020, we conducted in-depth interviews with four operational district TB supervisors, four clinicians and four nurses in charge of TB in referral hospitals, four nurses in charge of TB in health centers, and 28 caregivers with children currently or previously on TB treatment or TPT, and those who refused TPT for their eligible children. Data were audio recorded along with field notetaking. After verbatim transcription, data analyses were performed using a thematic approach. RESULTS The mean age of healthcare providers and caregivers were 40.19 years (SD 12.0) and 47.9 years (SD 14.6), respectively. Most healthcare providers (93.8%) were male, and 75.0% of caregivers were female. More than one-fourth of caregivers were grandparents, and 25.0% had no formal education. Identified key barriers to TPT implementation among children included TPT side effects, poor adherence to TPT, poor understanding of TPT among caregivers, TPT risk perception among caregivers, TPT's child-unfriendly formula, TPT supply-chain issues, caregivers' concern about the effectiveness of TPT, being non-parental caregivers, and poor community engagement. CONCLUSION Findings from this study suggest that the national TB program should provide more TPT training to healthcare providers and strengthen supply chain mechanisms to ensure adequate TPT drug supplies. Improving community awareness of TPT among caregivers should also be intensified. These context-specific interventions will play a crucial role in expanding the TPT program to interrupt the development from latent TB infection to active and ultimately lead to ending TB in the country.
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Affiliation(s)
- Yom An
- Sustaining Technical and Analytical Resources (STAR), the Public Health Institute (PHI), Phnom Penh, Cambodia. .,School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan. .,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Chan Yuda Huot
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sivanna Tieng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Kim Eam Khun
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.,National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Sok Heng Pheng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Chhenglay Leng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | | | - Ngak Song
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Daisuke Nonaka
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Siyan Yi
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA
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Busari AA, Oshikoya KA, Adejumo IA, Olanrewaju OA, Usman SO, Badru WA, Oreagba IA, Olayemi SO. Low prevalence of isoniazid preventive therapy uptake among HIV-infected patients attending tertiary health facility in Lagos, Southwest Nigeria. Pan Afr Med J 2021; 39:123. [PMID: 34527139 PMCID: PMC8418174 DOI: 10.11604/pamj.2021.39.123.28095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION the burden of HIV and tuberculosis co-infection is a global public health challenge. Despite the benefit of isoniazid preventive therapy (IPT) in reducing the rate of co-infection, the uptake is generally limited in developing countries. This study aimed to determine the prevalence of IPT use and the factors affecting the uptake among HIV-infected patients attending our Teaching Hospital. METHODS this cross-sectional survey involved 300 HIV-infected individuals attending the AIDS prevention initiatives in Nigeria clinic of the Lagos University Teaching Hospital. A self-designed and well-structured questionnaire was used to document the demographic data, patients' exposure to tuberculosis, and IPT uptake. Clinical data of eligible patients were also extracted from their case notes. The main outcome measure was the prevalence of IPT use and non-use. RESULTS out of the respondents evaluated, (72.7%, n = 218) were females. Tuberculosis was the predominant comorbidity (15.7%, n = 47) and majority (53.0%, n = 159) had a CD4 count of < 500 cells/ml. Overall prevalence of IPT uptake was very low (7.1%, n = 18) among HIV-infected patients. Major factors affecting uptake were lack of awareness of benefit (44.4%, n = 8) and lack of fear of contracting tuberculosis (22.2%, n = 4). However, lack of awareness of IPT benefit was the only independent factor associated with poor IPT uptake (adjusted odds 1168.75, 95% confidence interval: 85.05-16060.33; p = 0.001). CONCLUSION isoniazid preventive therapy uptake was found to be very low in this study. Increased awareness and policy implementation of IPT by the healthcare provider is necessary.
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Nabity SA, Gunde LJ, Surie D, Shiraishi RW, Kirking HL, Maida A, Auld AF, Odo M, Jahn A, Nyirenda RK, Oeltmann JE. Early-phase scale-up of isoniazid preventive therapy for people living with HIV in two districts in Malawi (2017). PLoS One 2021; 16:e0248115. [PMID: 33793577 PMCID: PMC8016323 DOI: 10.1371/journal.pone.0248115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Isoniazid preventive therapy (IPT) against tuberculosis (TB) is a life-saving intervention for people living with HIV (PLHIV). In September 2017, Malawi began programmatic scale-up of IPT to eligible PLHIV in five districts with high HIV and TB burden. We measured the frequency and timeliness of early-phase IPT implementation to inform quality-improvement processes. Methods and findings We applied a two-stage cluster design with systematic, probability-proportional-to-size sampling of six U.S. Centers for Disease Control and Prevention (CDC)-affiliated antiretroviral therapy (ART) centers operating in the urban areas of Lilongwe and Blantyre, Malawi (November 2017). ART clinic patient volume determined cluster size. Within each cluster, we sequentially sampled approximately 50 PLHIV newly enrolled in ART care. We described a quality-of-care cascade for intensive TB case finding (ICF) and IPT in PLHIV. PLHIV newly enrolled in ART care were eligibility-screened for hepatitis and peripheral neuropathy, as well as for TB disease using a standardized four-symptom screening tool. Among eligible PLHIV, the overall weighted IPT initiation rate was 70% (95% CI: 46%–86%). Weighted IPT initiation among persons aged <15 years (30% [95% CI: 12%–55%]) was significantly lower than among persons aged ≥15 years (72% [95% CI: 47%–89%]; Rao-Scott chi-square P = 0.03). HIV-positive children aged <5 years had a weighted initiation rate of only 13% (95% CI: 1%–79%). For pregnant women, the weighted initiation rate was 67% (95% CI: 32%–90%), similar to non-pregnant women aged ≥15 years (72% [95% CI: 49%–87%]). Lastly, 95% (95% CI: 92%–97%) of eligible PLHIV started ART within one week of HIV diagnosis, and 92% (95% CI: 73%–98%) of patients receiving IPT began on the same day as ART. Conclusions Early-phase IPT uptake among adults at ART centers in Malawi was high. Child uptake needed improvement. National programs could adapt this framework to evaluate their ICF-IPT care cascades.
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Affiliation(s)
- Scott A Nabity
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laurence J Gunde
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Diya Surie
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ray W Shiraishi
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hannah L Kirking
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alice Maida
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andrew F Auld
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Michael Odo
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Andreas Jahn
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Rose K Nyirenda
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - John E Oeltmann
- Global Tuberculosis Prevention and Control Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Hunter OF, Kyesi F, Ahluwalia AK, Daffé ZN, Munseri P, von Reyn CF, Adams LV. Successful implementation of isoniazid preventive therapy at a pediatric HIV clinic in Tanzania. BMC Infect Dis 2020; 20:738. [PMID: 33028260 PMCID: PMC7542689 DOI: 10.1186/s12879-020-05471-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/02/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In accordance with international guidance for tuberculosis (TB) prevention, the Tanzanian Ministry of Health recommends isoniazid preventive therapy (IPT) for children aged 12 months and older who are living with HIV. Concerns about tolerability, adherence, and potential mistreatment of undiagnosed TB with monotherapy have limited uptake of IPT globally, especially among children, in whom diagnostic confirmation is challenging. We assessed IPT implementation and adherence at a pediatric HIV clinic in Tanzania. METHODS In this prospective cohort study, eligible children living with HIV aged 1-15 years receiving care at the DarDar Pediatric Program in Dar es Salaam who screened negative for TB disease were offered a 6-month regimen of daily isoniazid. Patients could choose to receive IPT via facility- or community-based care. Parents/caregivers and children provided informed consent and verbal assent respectively. Isoniazid was dispensed with the child's antiretroviral therapy every 1-3 months. IPT adherence and treatment completion was determined by pill counts, appointment attendance, and self-report. Patients underwent TB symptom screening at every visit. RESULTS We enrolled 66 children between July and December 2017. No patients/caregivers declined IPT. Most participants were female (n = 43, 65.1%) and the median age was 11 years (interquartile range [IQR] 8, 13). 63 (95.5%) participants chose the facility-based model; due to the small number of participants who chose the community-based model, valid comparisons between the two groups could not be made. Forty-nine participants (74.2%) completed IPT within 10 months. Among the remaining 17, 11 had IPT discontinued by their provider due to adverse drug reactions, 5 lacked documentation of completion, and 1 had unknown outcomes due to missing paperwork. Of those who completed IPT, the average monthly adherence was 98.0%. None of the participants were diagnosed with TB while taking IPT or during a median of 4 months of follow-up. CONCLUSIONS High adherence and treatment completion rates can be achieved when IPT is integrated into routine, self-selected facility-based pediatric HIV care. Improved record-keeping may yield even higher completion rates. IPT was well tolerated and no cases of TB were detected. IPT for children living with HIV is feasible and should be implemented throughout Tanzania.
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Affiliation(s)
- Olivia F Hunter
- Dartmouth College, Hanover, NH, 03755, USA. .,, New York, USA.
| | - Furaha Kyesi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | | | | | - Patricia Munseri
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Lisa V Adams
- Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
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Tumusiime R, Mukasa C, Kisakya-Maria AK, Neumbe IM, Odyeny J, Maube B, Gavamukulya Y, Nekaka R. Baseline Assessment of Risk Factors of Presumptive Tuberculosis among under Five Children Living with an Index Client under Treatment in Mbale District, Eastern Uganda. MICROBIOLOGY RESEARCH JOURNAL INTERNATIONAL 2020; 30:1-8. [PMID: 34179569 PMCID: PMC8223506 DOI: 10.9734/mrji/2020/v30i530214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS Children in contact with adults having pulmonary Tuberculosis (TB) are vulnerable to TB infection and hence contact tracing and screening is important for early detection of infection. However, there are few contacts traced and the prevalence and risk factors for transmission are not well studied. The objective of this study was to determine the prevalence of infection and risk factors associated with TB transmission among under five children in household contact with adult pulmonary TB patients. MATERIALS AND METHODS A cross sectional study was carried out in three health facilities with a high TB burden in Mbale District, Eastern Uganda involving all under five household contacts of adults with pulmonary tuberculosis recorded in the TB register from October 2018 to March 2019 and still on treatment. Structured questionnaires were administered to the index clients to obtain their demographic and clinical data about TB, HIV as well as information on the children. Children were screened using the intensive case finding forms to identify presumptive cases. RESULTS The total number of index TB Clients line listed were 70. Number of clients traced was 38, 21 (%) of whom had children under five years and a total of 33 children were identified. The number of presumptive cases was 9/33 (27.27%). 77.8% of the presumptive cases were living in poorly ventilated houses. CONCLUSION The study identified children with presumptive TB and various risk factors for TB transmission. Intensive contact tracing can therefore help reduce TB transmission within the communities. It is recommended to undertake studies aiming at improving contact tracing and strategies to eliminate the risk factors to TB transmission.
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Affiliation(s)
- Rosemary Tumusiime
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Charles Mukasa
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Agatha K Kisakya-Maria
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Irene Mildred Neumbe
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Jerome Odyeny
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
| | - Bernard Maube
- Busiu Health Center IV, Mbale District Local Government, Mbale District, Uganda
| | - Yahaya Gavamukulya
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, Busitema University, P.O. Box, 1460, Mbale, Uganda
| | - Rebecca Nekaka
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box, 1460, Mbale, Uganda
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Mwangi PM, Wamalwa D, Marangu D, Obimbo EM, Ng’ang’a M. Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study. East Afr Health Res J 2019; 3:141-150. [PMID: 34308207 PMCID: PMC8279276 DOI: 10.24248/eahrj-d-19-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 10/29/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND HIV is the strongest risk factor for developing tuberculosis (TB) among people with latent or new Mycobacterium tuberculosis infection. Isoniazid preventive therapy (IPT) reduces the risk of active TB among people living with HIV by up to 62%. Despite evidence that IPT is safe and efficacious, its provision remains low globally. The current study aimed at documenting IPT uptake, adherence, and completion rates, as well as the correlates of IPT uptake among HIV-infected children in Kenya. The study also assessed the knowledge, attitude, and practices of health-care workers (HCWs) with regard to IPT. METHODS A health facility-based cross-sectional study was conducted. Data were collected from caregivers of HIV-infected children as well as HCWs using an interviewer-administered questionnaire. Logistic regression was used to determine the factors associated with IPT uptake. RESULTS The study enrolled 111 child-caregiver dyads. Most of the caregivers were female (n=75, 77.3%) and HIV-positive (n=82, 85.4%). The majority of children were male (n=65, 58.6%) and on ART (n=106, 95.5%). Overall, 59 children were on IPT (uptake of 53.2%, 95% confidence interval [CI], 43.9% to 62.4%). Out of the 25 children who had been on IPT for more than 6 months, 22 (88.0%) successfully completed the 6-month course of treatment. Further, 27 of the 34 children (78.4%) who were on IPT at the time of the study demonstrated satisfactory adherence to the therapy (no doses missed). The caregivers' attributes that were associated with IPT uptake included having a secondary school education (adjusted odds ratio [aOR] 0.13; 95% CI, 0.03 to 0.67) and having been on IPT (aOR 27.50; 95% CI, 5.39 to 140.28). The characteristics of children that were significantly associated with IPT uptake were higher median baseline CD4 count (P=.007) and higher median current CD4 count (P=.024). CONCLUSION The study demonstrated suboptimal IPT uptake but favourable adherence and treatment completion rates. There was almost universal awareness of IPT within the study sample. Furthermore, the majority of the HCWs had a favourable attitude towards IPT. However, the attendant IPT practices were inadequate, with majority of HCWs reporting that they had never initiated IPT, prescribed IPT within the last 12 months, or renewed an isoniazid prescription.
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Affiliation(s)
- Peninah M Mwangi
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Elizabeth M Obimbo
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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