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Gunde L, Wang A, Payne D, O'Connor S, Kabaghe A, Kalata N, Maida A, Kayira D, Buie V, Tauzi L, Sankhani A, Thawani A, Rambiki E, Ahimbisibwe A, Maphosa T, Kudiabor K, Nyirenda R, Mpunga J, Mbendera K, Nyasulu P, Kayigamba F, Farahani M, Voetsch AC, Brown K, Jahn A, Girma B, Mirkovic K. Characteristics of TPT initiation and completion among people living with HIV. IJTLD OPEN 2024; 1:11-19. [PMID: 38799089 PMCID: PMC11119003 DOI: 10.5588/ijtldopen.23.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND TB preventive treatment (TPT) reduces morbidity and mortality among people living with HIV (PLHIV). Despite the successful scale-up of TPT in Malawi, monitoring and evaluation have been suboptimal. We utilized the Malawi Population-Based HIV Impact Assessment (MPHIA) 2020-2021 survey data to estimate TPT uptake and completion among self-reported HIV-positive persons. METHODS We estimated the proportion of HIV-positive respondents who had ever undergone TPT, and determined the percentage of those currently on TPT who had completed more than 6 months of treatment. Bivariate and multivariable logistic regression were performed to calculate the odds ratios for factors associated with ever-taking TPT. All variables were self-reported, and the analysis was weighted and accounted for in the survey design. RESULTS Of the HIV+ respondents, 38.8% (95% CI 36.4-41.3) had ever taken TPT. The adjusted odds of ever taking TPT were 8.0 and 5.2 times as high in the Central and Southern regions, respectively, compared to the Northern region; 1.9 times higher among those in the highest wealth quintile, and 2.1 times higher for those on antiretroviral therapy >10 years. Of those currently taking TPT, 56.2% completed >6 months of TPT. CONCLUSION These results suggest low TPT uptake and >6 months' completion rates among self-reported HIV+ persons. Initiatives to create demand and strengthen adherence would improve TPT uptake.
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Affiliation(s)
- L Gunde
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | - A Wang
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | - D Payne
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | | | - A Kabaghe
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | - N Kalata
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | - A Maida
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | - D Kayira
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | - V Buie
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
| | - L Tauzi
- Lighthouse Trust, Lilongwe, Malawi
| | | | | | | | - A Ahimbisibwe
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Lilongwe, Malawi
| | - T Maphosa
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Lilongwe, Malawi
| | - K Kudiabor
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Lilongwe, Malawi
| | - R Nyirenda
- Department of HIV/AIDS, STI and Viral Hepatitis, Ministry of Health, Lilongwe, Malawi
| | - J Mpunga
- National TB and Leprosy Elimination Program, Ministry of Health, Lilongwe, Malawi
| | - K Mbendera
- National TB and Leprosy Elimination Program, Ministry of Health, Lilongwe, Malawi
| | - P Nyasulu
- Department of HIV/AIDS, STI and Viral Hepatitis, Ministry of Health, Lilongwe, Malawi
- International Training & Education Center for Health (I-TECH) Department of Global Health, University of Washington, Lilongwe, Malawi
| | | | - M Farahani
- ICAP at Columbia University, New York, USA
| | | | | | - A Jahn
- Department of HIV/AIDS, STI and Viral Hepatitis, Ministry of Health, Lilongwe, Malawi
- International Training & Education Center for Health (I-TECH) Department of Global Health, University of Washington, Lilongwe, Malawi
| | - B Girma
- National TB and Leprosy Elimination Program, Ministry of Health, Lilongwe, Malawi
- International Training & Education Center for Health (I-TECH) Department of Global Health, University of Washington, Lilongwe, Malawi
| | - K Mirkovic
- U.S. Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi
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Onyango DO, van der Sande MAB, Yuen CM, Mecha J, Matemo D, Oele E, Kinuthia J, John‐Stewart G, LaCourse SM. Drop-offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015-2019. J Int AIDS Soc 2022; 25:e25939. [PMID: 35927793 PMCID: PMC9352867 DOI: 10.1002/jia2.25939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Isoniazid preventive therapy (IPT) can reduce the risk of tuberculosis (TB) in children living with HIV (CLHIV), but data on the outcomes of the IPT cascade in CLHIV are limited. METHODS We evaluated the IPT cascade among CLHIV aged <15 years and newly enrolled in HIV care in eight HIV clinics in western Kenya. Medical record data were abstracted from September 2015 through July 2019. We assessed the proportion of CLHIV completing TB symptom screening, IPT eligibility assessment, IPT initiation and completion. TB incidence rate was calculated stratified by IPT initiation and completion status. Risk factors for IPT non-initiation and non-completion were assessed using Poisson regression with generalized linear models. RESULTS Overall, 856 CLHIV were newly enrolled in HIV care, of whom 98% ([95% CI 97-99]; n = 841) underwent screening for TB symptoms and IPT eligibility. Of these, 13 (2%; 95% CI 1-3) were ineligible due to active TB and 828 (98%; 95% CI 97-99) were eligible. Five hundred and fifty-nine (68%; 95% CI 64-71) of eligible CLHIV initiated IPT; median time to IPT initiation was 3.6 months (interquartile range [IQR] 0.5-10.2). Overall, 434 (78%; 95% CI 74-81) IPT initiators completed. Attending high-volume HIV clinics (aRR = 2.82; 95% CI 1.20-6.62) was independently associated with IPT non-initiation. IPT non-initiation had a trend of being higher among those enrolled in the period 2017-2019 versus 2015-2016 (aRR = 1.91; 0.98-3.73) and those who were HIV virally non-suppressed (aRR = 1.90; 95% CI 0.98-3.71). Being enrolled in 2017-2019 versus 2015-2016 (aRR = 1.40; 1.01-1.96) was independently associated with IPT non-completion. By 24 months after IPT screening, TB incidence was four-fold higher among eligible CLHIV who never initiated (8.1 per 1000 person years [PY]) compared to CLHIV who completed IPT (2.1 per 1000 PY; rate ratio [RR] = 3.85; 95% CI 1.08-17.15), with a similar trend among CLHIV who initiated but did not complete IPT (8.2/1000 PY; RR = 4.39; 95% CI 0.82-23.56). CONCLUSIONS Despite high screening for eligibility, timely IPT initiation and completion were suboptimal among eligible CLHIV in this programmatic cohort. Targeted programmatic interventions are needed to address these drop-offs from the IPT cascade by ensuring timely IPT initiation after ruling out active TB and enhancing completion of the 6-month course to reduce TB in CLHIV.
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Affiliation(s)
- Dickens Otieno Onyango
- Kisumu County Department of HealthKisumuKenya
- Institute of Tropical MedicineAntwerpBelgium
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Marianne A. B. van der Sande
- Institute of Tropical MedicineAntwerpBelgium
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Jerphason Mecha
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Daniel Matemo
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | | | - John Kinuthia
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Division of Allergy and Infectious DiseasesDepartment of Medicine, University of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Sylvia M. LaCourse
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Division of Allergy and Infectious DiseasesDepartment of Medicine, University of WashingtonSeattleWashingtonUSA
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