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Adepoju VA, Adelekan A, Adepoju OE, Onyezue OI, Imoyera W, Nkeiruka A, Olofinbiyi AB. Barriers and Facilitators of Isoniazid Preventive Therapy Implementation among People Living with HIV in Nigeria: A Scoping Review of the Literature. West Afr J Med 2023; 40:336-344. [PMID: 37018383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Implementation of Isoniazid Preventive Therapy (IPT) among People Living with HIV (PLHIV) continues to be a significant challenge, and there is a shortage of effective interventions. This scoping review aimed to determine barriers and facilitators of IPT implementation including its uptake and completion among PLHIV in Nigeria. METHODS PubMed, Medline Ovid, Scopus, Google scholar, web of science and Cochrane Library were searched for articles published between January 2019 to June 2022 that addressed barriers and facilitators of IPT uptake and completion in Nigeria. The study used the PRISMA checklist to ensure the quality of the study. RESULTS The initial search revealed 780 studies, of which 15 studies were finally included in the scoping review. The authors inductively organized IPT barriers among PLHIV into patients-, health system-,programmatic- and provider-related barriers. Facilitators of IPT were sub-categorized into programmatic (Monitoring and Evaluation or logistic), patient-related and provider-related (capacity building) and health systems sub-categories. Most studies highlighted more barriers than facilitators, and across all studies, IPT uptake was 3% - 61.2% while IPT completion was 40 - 87.9% but these figures are higher in quality improvement studies. CONCLUSION Identified barriers include health system, and programmatic-across, and in all the studies, IPT uptake was 3%-61.2%. Cost-effective and locally developed interventions addressing context-specific barriers should be developed to address patient, provider, programmatic, and health systems-specific findings in our study with a clear understanding that there may be other barriers limiting uptake and completion of IPT at the level of community and caregivers.
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Affiliation(s)
- V A Adepoju
- Department of HIV and Infectious Diseases, Jhpiego (an affiliate of John Hopkins University), Abuja, Nigeria. ;
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Ekiti State, Nigeria
| | - A Adelekan
- Blue Gate Research Institute, Ibadan, Oyo State, Nigeria
| | - O E Adepoju
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Ekiti State, Nigeria
| | - O I Onyezue
- Prevention and Community Directorate , APIN Public Health Initiatives, Nigeria
| | - W Imoyera
- Department of HIV and Infectious Diseases, Jhpiego (an affiliate of John Hopkins University), Abuja, Nigeria. ;
| | - A Nkeiruka
- Department of HIV/AIDS, Achieving Health Nigeria Initiative, Nigeria
| | - A B Olofinbiyi
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Ekiti State, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Mandima P, Baltrusaitis K, Montepiedra G, Aaron L, Mathad J, Onyango-Makumbi C, Nyati M, Ngocho J, Chareka G, Ponatshego P, Masheto G, McCarthy K, Jean-Philippe P, Gupta A, Stranix-Chibanda L. Prevalence of neurotoxicity symptoms among postpartum women on isoniazid preventive therapy and efavirenz-based treatment for HIV: an exploratory objective of the IMPAACT P1078 randomized trial. BMC Pregnancy Childbirth 2023; 23:34. [PMID: 36650479 PMCID: PMC9847058 DOI: 10.1186/s12884-022-05341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This exploratory analysis investigates the prevalence and risk factors of neurocognitive toxicity in postpartum women on HIV treatment in response to a concern of an Isoniazid Preventive Therapy (IPT)/Efavirenz interaction. TRIAL DESIGN Pregnant women on HIV treatment from countries with high TB prevalence were randomized in IMPAACT P1078 to 28 weeks of IPT started either during pregnancy or at 12 weeks postpartum. Partway through study implementation, the Patient Health Questionnaire 9, the cognitive complaint questionnaire, and the Pittsburg Sleep Quality Index were added to evaluate depression, cognitive function, and sleep quality at postpartum weeks. Screening for peripheral neuropathy was conducted throughout the study. METHODS We summarized percentages of women with depression symptoms, cognitive dysfunction, poor sleep quality and peripheral neuropathy and assessed the association of 11 baseline risk factors of neurotoxicity using logistic regression, adjusted for gestational age stratum. RESULTS Of 956 women enrolled, 749 (78%) had at least one neurocognitive evaluation. During the postpartum period, the percentage of women reporting at least mild depression symptoms, cognitive complaint and poor sleep quality peaked at 13%, 8% and 10%, respectively, at 12 weeks, and the percentage of women reporting peripheral neuropathy peaked at 13% at 24 weeks. There was no evidence of study arm differences in odds of all four neurotoxic symptoms. CONCLUSIONS Timing of IPT initiation and EFV use were not associated with symptoms of neurotoxicity. Further study is advised to formally assess risk factors of neurotoxicity.
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Affiliation(s)
- Patricia Mandima
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.
| | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Grace Montepiedra
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lisa Aaron
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jyoti Mathad
- Weill Cornell Medical College, New York, NY, USA
| | | | - Mandisa Nyati
- Chris Hani Baragwanath Hospital, Johannesburg, Soweto, South Africa
| | - James Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gift Chareka
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | | | | | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Lynda Stranix-Chibanda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Nyarubamba RF, Silumbwe A, Jacobs C, Maritim P, Mdoe P, Zulu JM. Assessment of contextual factors shaping delivery and uptake of isoniazid preventive therapy among people living with HIV in Dar es salaam, Tanzania. BMC Infect Dis 2022; 22:884. [PMID: 36434517 PMCID: PMC9700944 DOI: 10.1186/s12879-022-07867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tuberculosis has remained a leading cause of death among people living with HIV (PLHIV) globally. Isoniazid preventive therapy (IPT) is the recommended strategy by the World Health Organization to prevent TB disease and related deaths among PLHIV. However, delivery and uptake of IPT has remained suboptimal particularly in countries where HIV and TB are endemic such as Tanzania. This study sought to assess contextual factors that shape delivery and uptake of IPT in Dar es Salaam region, Tanzania. METHODOLOGY We employed a qualitative case study design comprising of in-depth interviews with people living with HIV (n = 17), as well as key informant interviews with clinicians (n = 7) and health administrators (n = 7). We used thematic data analysis approach and reporting of the results was guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Characteristics of IPT such as aligning the therapy to individual patient schedules and its relatively low cost facilitated its delivery and uptake. On the contrary, perceived adverse side effects negatively affected the delivery and uptake of IPT. Characteristics of individuals delivering the therapy including their knowledge, good attitudes, and commitment to meeting set targets facilitated the delivery and uptake of IPT. The process of IPT delivery comprised collective planning and collaboration among various facilities which facilitated its delivery and uptake. Organisational characteristics including communication among units and supportive leadership facilitated the delivery and uptake of IPT. External system factors including HIV stigma, negative cultural and religious values, limited funding as well as shortage of skilled healthcare workers presented as barriers to the delivery and uptake of IPT. CONCLUSION The factors influencing the delivery and uptake of IPT among people living with HIV are multifaceted and exist at different levels of the health system. Therefore, it is imperative that IPT program implementers and policy makers adopt multilevel approaches that address the identified barriers and leverage the facilitators in delivery and uptake of IPT at both community and health system levels.
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Affiliation(s)
- Renatus Fabiano Nyarubamba
- Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia. .,Ministry of Health, Community Development, Gender Elderly and Children, Dodoma, Tanzania.
| | - Adam Silumbwe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia. .,Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Choolwe Jacobs
- grid.12984.360000 0000 8914 5257Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Patricia Maritim
- grid.12984.360000 0000 8914 5257Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Paschal Mdoe
- grid.461293.b0000 0004 1797 1065Haydom Lutheran Hospital, Manyara, Tanzania ,grid.5379.80000000121662407Division of Nursing, Midwifery and Social Works, University of Manchester, Faculty of Biology Medicine and Health, Manchester, UK
| | - Joseph Mumba Zulu
- grid.12984.360000 0000 8914 5257Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
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Benoit Vásquez GI, Morrobel AL, Benjumea-Bedoya D, Del Corral-Londoño H. Barriers and facilitators for isoniazid preventive therapy (IPT) administration in children under 5 years of age in the Dominican Republic. BMC Infect Dis 2022; 22:359. [PMID: 35410136 PMCID: PMC8996516 DOI: 10.1186/s12879-022-07333-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Throughout the world tuberculosis (TB) is the second leading cause of death due to an infectious agent. The World Health Organization promotes Isoniazid Preventive Therapy (IPT) in children under 5 years who are contacts of persons diagnosed with smear-positive pulmonary TB (SPPTB). In 2019, 33% of children identified as contacts received IPT globally, while in the Americas 11 countries reached coverages ≥ 75%, only 35% did so in the Dominican Republic (DR). The aim of this study was to identify barriers and facilitators for IPT administration in children under 5 in the Area IV Directorate of Health of the DR’s National District. Methods Descriptive study, using mixed methods and sequential explanatory approach. We characterized children under 5 years who were contacts of a person with SPPTB. Later, semi-structured interviews and content analysis allowed identification of barriers and facilitators for IPT administration in children who were contacts of a person diagnosed with SPPTB, as perceived by relatives and health system personnel. Results A total of 238 children were identified as contacts of 174 persons with SPPTB: 36% of these received IPT while no data on IPT administration was found for 11% of them. The proportion of children who had a tuberculin skin test (TST) done was < 20%. However, those who had the test done had a greater opportunity to receive IPT (OR: 8.12, CI 95%: 1.60–41.35). Barriers identified include socioeconomic conditions of children and families, stigma, lack of information in clinical and follow-up records, lack of coordination between public and private providers and lack of coherence within national regulations. Facilitators include home based care of persons with TB and their contacts, transfer of treatment to a health centre near household, isoniazid availability, provision of information by health-workers and economic support for food and transportation. Conclusions Incomplete data, lack of use of TST to rule out active TB, socioeconomic and cultural conditions, were barriers for IPT administration. Implementation of a person centred approach to care was found to be the main facilitator for IPT uptake. Administration of IPT depends predominantly on modifiable health system factors. This allows rapid identification of strategies to improve IPT administration.
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Affiliation(s)
- Grey Idalia Benoit Vásquez
- Administradora de Estancias Infantiles Salud Segura, Santo Domingo, Dominican Republic. .,National Directorate of Epidemiology (DIGEPI), Ministry of Public Health, Santo Domingo, Dominican Republic. .,Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
| | - Ana Lucia Morrobel
- Programa de Control de Tuberculosis, Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Dione Benjumea-Bedoya
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.,Grupo de Investigación en Salud Familiar y Comunitaria. Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia
| | - Helena Del Corral-Londoño
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.,Grupo de investigación MICROBA, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
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Sharma N, Basu S, Khanna A, Sharma P, Chopra KK, Chandra S. Adherence to Isoniazid Preventive Therapy among children living with tuberculosis patients in Delhi, India: An exploratory prospective study. Indian J Tuberc 2022; 69:100-103. [PMID: 35074140 DOI: 10.1016/j.ijtb.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 06/14/2023]
Abstract
INH Preventive Therapy (IPT) substantially reduces the risk of incidence of TB disease in pediatric household contacts of TB patients. The National TB Elimination Program (NTEP) of India prescribes a daily regimen of Isoniazid to all under-6 pediatric contacts for 6 months duration. We conducted, this exploratory prospective study (June to Nov' 2020) to assess adherence to IPT and reasons for nonadherence among child contacts of microbiologically confirmed, drug sensitive, non-PLHIV Tuberculosis patients in Delhi, India. The study outcomes included the initiation, adherence and completion of IPT. The caregivers of the child TB contacts were interviewed face to face by the field investigator. The data were entered on EpiData 3.1 and analysed with IBM SPSS 25. The INH adherence was assessed in a total of 86 household child TB contacts. IPT had been initiated in 62 (72.1%) child TB contacts of which 61 (98.4%) received INH within 1 month of starting of ATT-DOTS therapy in the index TB patient of the household. Furthermore, the failure to initiate IPT was reported by 24 (27.9%) child TB contacts. Within the cohort of child TB contacts who were not initiated with IPT, the ATT-DOTS duration in the index-TB patient was ≥5 months in 18 (75%) cases, 1-2 months in 3 (12.5%) cases, and <1 month in also 3 (12.5%) cases. Reasons for non-initiation (n = 24) were reported as refusal by the family in 12 (50%) cases mostly due to concern over side-effects of the drug, while non-provision of the drug by the DOTS provider was also observed in 12 (50%) cases. The mean (SD) INH adherence in the INH initiated cohort was 5.6 (2.0) (n = 62). Reasons for INH non-adherence were attributed to forgetfulness (n = 23, 37.1%), carelessness (n = 24, 38.7%), and intermittent stopping of the medication (n = 17, 27.4%) on the child falling sick, perceived drug side effects, and running out of drug stocks. INH non-adherence defined as at-least two missed INH doses in the previous 7 days was observed in 47 (54.7%) participants (n = 86). On bivariate analysis, none of the household sociodemographic characteristics showed any statistically significant association with the rate of INH non-adherence in the child TB contacts. The findings of the present study indicate the need to periodically assess adherence and persistence to IPT in the child TB contacts as high intermittent missed dosing rates can undermine the effectiveness of IPT in preventing incident disease.
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Affiliation(s)
- Nandini Sharma
- Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Saurav Basu
- Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India.
| | | | - Pragya Sharma
- Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India
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Takamiya M, Takarinda K, Balachandra S, Godfrey M, Radin E, Hakim A, Pearson ML, Choto R, Sandy C, Maphosa T, Rogers JH. Isoniazid preventive therapy use among adult people living with HIV in Zimbabwe. Int J STD AIDS 2021; 32:1020-1027. [PMID: 33978529 PMCID: PMC10719553 DOI: 10.1177/09564624211014404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed the prevalence of isoniazid preventive therapy (IPT) uptake and explored factors associated with IPT non-uptake among people living with HIV (PLHIV) using nationally representative data from the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) 2015-2016. This was a cross-sectional study of 3418 PLHIV ZIMPHIA participants eligible for IPT, aged ≥15 years and in HIV care. Logistic regression modeling was performed to assess factors associated with self-reported IPT uptake. All analyses accounted for multistage survey design. IPT uptake among PLHIV was 12.7% (95% confidence interval (CI): 11.4-14.1). After adjusting for sex, age, rural/urban residence, TB screening at the last clinic visit, and hazardous alcohol use, rural residence was the strongest factor associated with IPT non-uptake (adjusted OR (aOR): 2.39, 95% CI: 1.82-3.12). Isoniazid preventive therapy non-uptake having significant associations with no TB screening at the last HIV care (aOR: 2.07, 95% CI: 1.54-2.78) and with hazardous alcohol use only in urban areas (aOR: 10.74, 95% CI: 3.60-32.0) might suggest suboptimal IPT eligibility screening regardless of residence, but more so in rural areas. Self-reported IPT use among PLHIV in Zimbabwe was low, 2 years after beginning national scale-up. This shows the importance of good TB screening procedures for successful IPT implementation.
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Affiliation(s)
| | | | | | | | | | - Avi Hakim
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Regis Choto
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Talent Maphosa
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
| | - John H Rogers
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
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Lwevola P, Izudi J, Kimuli D, Komuhangi A, Okoboi S. Low level of tuberculosis preventive therapy incompletion among people living with Human Immunodeficiency Virus in eastern Uganda: A retrospective data review. J Clin Tuberc Other Mycobact Dis 2021; 25:100269. [PMID: 34504952 DOI: 10.1016/j.jctube.2021.100269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction In most developing countries, tuberculosis (TB) is the leading cause of mortality among people living with the Human Immunodeficiency Virus (PLHIV). Uganda implements TB preventive therapy (TPT) using Isoniazid but data are limited about TPT incompletion. We, therefore, assessed the magnitude of TPT incompletion and the associated factors among PLHIV in a large rural referral health facility in rural eastern Uganda. Methods and materials We conducted a retrospective data review for PLHIV initiated on TPT between October 2018 and September 2019. The outcome variable was TPT incompletion defined as the failure to finish 6 consecutive months of Isoniazid or failure to finish 9 months of Isoniazid without stopping for more than 2 months at a time. We descriptively summarized numerical data using frequencies and percentages and compared differences in the outcome with independent variables using the Chi-square or fisher’s exact, and the Student’s t-tests. We used a generalized linear model to assess factors independently associated with TPT incompletion, reported using adjusted odds ratio (aOR) and 95% confidence interval (CI). Results We enrolled 959 participants with a mean age of 41.1 ± 13.8 years, 561 (58.5%) were females, 663 (69.1%) married, 538 (56.1) travelled 5–10 km from their place of residence to the ART clinic, 293 (30.6%) had disclosed HIV status, 362 (37.7%) had been on ART for 5–9 years, and 923 (96.2%) were on first-line ART regimen. We found 26 (2.7%) participants had incomplete TPT. Non-adherence to ART clinic visits (aOR, 2.81; 95% CI, 1.09–7.73), history of switch in ART regimen (aOR, 9.33; 95% CI, 1.19–52.39), patient representation (aOR, 4.70; 95% CI, 1.35–13.99), and one unit increase in ongoing counselling session (aOR, 0.67; 95% CI, 0.46–0.91) were associated with TPT incompletion. Conclusion We found low rates of TPT incompletion among PLHIV in rural eastern Uganda. Non-adherence to ART clinic visits, patient representation, and history of switch in ART regimen is associated with a higher likelihood of TPT incompletion while ongoing counselling is associated with a reduction in TPT incompletion. The health system should address non-adherence to ART clinic visits and patient representation, through ongoing psychosocial support.
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Gatechompol S, Harnpariphan W, Supanan R, Suwanpimolkul G, Sophonphan J, Ubolyam S, Kerr SJ, Avihingsanon A, Kawkitinarong K. Prevalence of latent tuberculosis infection and feasibility of TB preventive therapy among Thai prisoners: a cross-sectional study. BMC Public Health 2021; 21:1206. [PMID: 34162348 PMCID: PMC8223292 DOI: 10.1186/s12889-021-11271-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prisons are considered as major reservoirs for tuberculosis. Preventive therapy for latent TB infection (LTBI) is an adjunctive strategy to control TB. However, LTBI data in Thai prisoners is limited. This study assessed the prevalence of LTBI and feasibility of isoniazid preventive therapy (IPT). METHODS A cross-sectional study was conducted among prisoners in Klong Prem Central Prison, Bangkok. Participants were screened for active TB by questionnaire and chest X-ray. LTBI was evaluated by Tuberculin skin test (TST) and QuantiFERON-TB Gold Plus (QFTP) among subgroup. Participants with positive TST or QFTP were considered to have LTBI. Participants with LTBI were offered IPT. RESULTS From August 2018-November 2019, 1002 participants were analyzed. All participants were male with a median age of 38 (IQR 32-50) years. LTBI identified by either TST/QFTP was present in 466 (46.5%) participants. TST was positive in 359 (36%) participants. In the subgroup of 294 participants who had both TST and QFTP results, 181/294 (61.6%) tested positive by QFTP. Agreement between TST and QFTP was 55.1% (Kappa = 0.17). The risk factors associated with LTBI were previous incarceration (aOR 1.53, 95%CI, 1.16-2.01, p = 0.002), history of prior active TB (aOR 3.02, 95%CI, 1.74-5.24, p < 0.001) and duration of incarceration ≥10 years (aOR 1.86, 95%CI, 1.24-2.79, p = 0.003). Majority of LTBI participants (82%) agreed to take IPT. Three hundred and 56 (93%) participants completed treatment whereas 27 (7%) participants discontinued IPT due to the side effects of INH. CONCLUSION This is the first study to evaluate the prevalence of LTBI and feasibility of IPT among Thai prisoners. LTBI prevalence in male prisoners in Thailand is high. LTBI screening and treatment should be implemented together with other preventive components.
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Affiliation(s)
- Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand. .,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Weerakit Harnpariphan
- Medical Correctional Institution, Bangkok and Klong Prem Central Prison, Bangkok, Thailand
| | - Ruamthip Supanan
- Medical Correctional Institution, Bangkok and Klong Prem Central Prison, Bangkok, Thailand
| | - Gompol Suwanpimolkul
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiratchaya Sophonphan
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Sasiwimol Ubolyam
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamon Kawkitinarong
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Lodi S, Emenyonu NI, Marson K, Kwarisiima D, Fatch R, McDonell MG, Cheng DM, Thirumurthy H, Gandhi M, Camlin CS, Muyindike WR, Hahn JA, Chamie G. The Drinkers' Intervention to Prevent Tuberculosis (DIPT) trial among heavy drinkers living with HIV in Uganda: study protocol of a 2×2 factorial trial. Trials 2021; 22:355. [PMID: 34016158 PMCID: PMC8136096 DOI: 10.1186/s13063-021-05304-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background The risk of tuberculosis (TB) is high among people with HIV (PWH). Heavy alcohol drinking independently increases TB risk and approximately 25% of PWH globally engage in heavy drinking. While isoniazid (INH) preventive therapy decreases TB incidence and mortality among PWH, heavy drinking during INH is associated with liver toxicity and poor adherence. Interventions are, therefore, urgently needed to decrease alcohol use and improve adherence to INH in this population in settings with high prevalence of HIV and TB like Uganda. Methods The Drinkers’ Intervention to Prevent TB (DIPT) study is a 2×2 factorial randomized controlled trial among HIV/TB co-infected adults (≥18 years) who engage in heavy alcohol drinking and live in Uganda. The trial will allocate 680 participants with a 1:1:1:1 individual randomization to receive 6 months of INH and one of the following interventions: (1) no incentives (control), (2) financial incentives contingent on low alcohol use, (3) financial incentives contingent on high adherence to INH, and (4) escalating financial incentives for both decreasing alcohol use and increasing adherence to INH. Incentives will be in the form of escalating lottery-based monetary rewards. Participants will attend monthly visits to refill isoniazid medications, undergo liver toxicity monitoring, and, except for controls, determine eligibility for prizes. We will estimate (a) the effect of incentives contingent on low alcohol use on reduction in heavy drinking, measured via a long-term objective and self-reported metric of alcohol use, at 3- and 6-month study visits, and (b) the effect of incentives contingent on high adherence to INH, measured as >90% pill-taking days by medication event monitoring system cap opening. We will use qualitative methods to explore the mechanisms of any influence of financial incentives on HIV virologic suppression. Discussion This study will provide new information on low-cost strategies to both reduce alcohol use and increase INH adherence among people with HIV and TB infection who engage in heavy drinking in low-income countries with high HIV and TB prevalence. Trial registration ClinicalTrials.gov NCT03492216. Registered on April 10, 2018
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Affiliation(s)
- Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Nneka I Emenyonu
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Kara Marson
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | | | - Robin Fatch
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Monica Gandhi
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - Winnie R Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Judith A Hahn
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
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10
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Komba FF, Frumence G. Facility and patient barriers in the implementation of isoniazid preventive therapy for people living with HIV attending Care and Treatment Centers, Songea Municipality, Tanzania. Pan Afr Med J 2021; 38:197. [PMID: 33995803 PMCID: PMC8106798 DOI: 10.11604/pamj.2021.38.197.26752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/06/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction isoniazid preventive therapy for people living with HIV is an essential public health intervention in low-income countries with high tuberculosis and HIV burden. Despite available evidence that it is efficacious, its implementation is still low in many countries. This study was designed to determine its implementation coverage and explore barriers for suboptimal implementation in Songea municipality in Tanzania. Methods a cross-sectional descriptive study design using both quantitative and qualitative approaches of data collection was employed. A review of 2148 records of people living with HIV eligible for isoniazid preventive therapy (IPT) was done to determine its implementation coverage. Twenty-one (21) in-depth interviews and 5 observations were conducted to explore barriers in the implementation. Quantitative data was analyzed using Statistical Package for the Social Science (SPSS) for windows version 20 statistical software. Descriptive statistics (frequencies and percentage) were employed and data were visualized using tables and bar graphs. All interviews were audio-recorded and analyzed using thematic analysis approach. Results overall, isoniazid preventive therapy coverage at Songea municipality was estimated to be 45%. Insufficient drug supply and stock out, shortage of staff, lack of service privacy, long waiting time, drug side effects, pills burden, distance and cost of transport were the main reported barriers hindering full scale implementation of isoniazid preventive therapy. Conclusion implementation of isoniazid preventive therapy in Songea municipality had low coverage. The study recommends that tuberculosis and HIV stakeholders must be part of the solutions by ensuring that the identified barriers are addressed.
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Affiliation(s)
- Festo Faustine Komba
- USAID, Sustaining Health Outcomes through the Private Sector (SHOPS) Plus Project, Dar es Salam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salam, Tanzania
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11
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Maokola W, Ngowi B, Lawson L, Robert M, Mahande M, Todd J, Msuya S. Coverage of isoniazid preventive therapy among people living with HIV; A retrospective cohort study in Tanzania (2012-2016). Int J Infect Dis 2021; 103:562-7. [PMID: 33276111 DOI: 10.1016/j.ijid.2020.11.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 01/25/2023] Open
Abstract
There was low IPT initiation among those who were eligible. Female sex, ART, obesity and WHO clinical stage II, enrolment in Njombe region and being in public hospitals were associated with increased IPT initiation. Strategies are needed to work on barriers and to sustain enabling factors to improve IPT initiation.
Background Isoniazid Preventive Therapy (IPT) is a proven public health tool to reduce Tuberculosis (TB) among people living with HIV. However, its implementation in most countries is suboptimal. This retrospective study was conducted to determine the coverage and factors associated with IPT initiation to inform program scale up and improve quality of service in Tanzania and elsewhere. Methods Retrospective cohort study design involving HIV clinics in Dar es Salaam, Iringa and Njombe regions from January 2012 to December 2016. Results A total of 171,743 PLHIV were in the cohort from 2012 to 2016. Of these, 166,709 were involved in the analysis. Of those analyzed, 23,970 (14.38%) were ever initiated on IPT. Female sex (aOR = 1.72, 95% CI: 1.13, P < 0.001), obesity (aOR = 1.29, 95% CI:1.20−1.39, P < 0.001), WHO clinical stage II (aOR = 1.48, 95% CI: 1.42−1.55, P < 0.001), enrolment in hospitals (aOR = 1.98, 95% CI: 1.89−2.06, P < 0.001), enrolment in Njombe region (aOR = 1.25: 95% CI: 1.18−1.33, P < 0.001) and enrolment in public health facilities (aOR = 1.93: 95% CI: 1.82−2.04, P < 0.001) were associated with increased IPT uptake. Being on ART (aOR = 0.67, 95% CI: 0.65−0.70, P < 0.001) and severe nutritional status (aOR = 0.72, 95% CI: 0.60−0.88, P < 0.001) were associated with decreased IPT initiation. Conclusions Our study documented low IPT initiation in the study area as well as documented factors which enable IPT initiation and those which impair IPT initiation. Strategies are needed to work on barriers and sustain enabling factors to improve IPT coverage.
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12
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Hirsch-Moverman Y, Mantell JE, Lebelo L, Howard AA, Hesseling AC, Nachman S, Frederix K, Maama LB, El-Sadr WM. Provider attitudes about childhood tuberculosis prevention in Lesotho: a qualitative study. BMC Health Serv Res 2020; 20:461. [PMID: 32450858 PMCID: PMC7249694 DOI: 10.1186/s12913-020-05324-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The World Health Organization estimated that 1.12 million children developed tuberculosis (TB) in 2018, and at least 200,000 children died from TB. Implementation of effective child contact management is an important strategy to prevent childhood TB but these practices often are not prioritized or implemented, particularly in low- and middle-income countries. This study aimed to explore attitudes of healthcare providers toward TB prevention and perceived facilitators and challenges to child contact management in Lesotho, a high TB burden country. Qualitative data were collected via group and individual in-depth interviews with 12 healthcare providers at five health facilities in one district and analyzed using a thematic framework. RESULTS Healthcare providers in our study were interested and committed to improve child TB contact management and identified facilitators and challenges to a successful childhood TB prevention program. Facilitators included: provider understanding of the importance of TB prevention and enhanced provider training on child TB contact management, with a particular focus on ruling out TB in children and addressing side effects. Challenges identified by providers were at multiple levels -- structural, clinic, and individual and included: [1] access to care, [2] supply-chain issues, [3] identification and screening of child contacts, and [4] adherence to isoniazid preventive therapy. CONCLUSIONS Given the significant burden of TB morbidity and mortality in young children and the recent requirement by the WHO to report IPT initiation in child contacts, prioritization of child TB contact management is imperative and should include enhanced provider training on childhood TB and mentorship as well as strategies to eliminate challenges. Strategies that enable more efficient child TB contact management delivery include creating standardized tools that facilitate the implementation, tracking, and monitoring of child TB contact management coupled with guidance and mentorship from the district health management team. To tackle access to care challenges, we propose delivering intensive community health education, conducting community screening more efficiently using standardized tools, and facilitating access to services in the community.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
| | - Joanne E. Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, at the New York State Psychiatric Institute and Columbia University Irving Medical Center, Department of Psychiatry, New York, NY USA
| | - Limakatso Lebelo
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
| | - Andrea A. Howard
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
| | - Anneke C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Sharon Nachman
- Pediatric Infectious Diseases, SUNY Stony Brook, Stony Brook, NY USA
| | - Koen Frederix
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
| | | | - Wafaa M. El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
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13
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Miyahara R, Piyaworawong S, Prachamat P, Wongyai J, Bupachat S, Yamada N, Summanapan S, Yanai H, Mahasirimongkol S. High tuberculosis burden among HIV-infected populations in Thailand due to a low-sensitivity tuberculin skin test. J Infect Public Health 2019; 13:657-660. [PMID: 31563472 DOI: 10.1016/j.jiph.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022] Open
Abstract
The current Thai guideline recommends that among people living with HIV, isoniazid preventive therapy (IPT) should be given to those with a positive tuberculin skin test (TST). We conducted a case-control study, nested within a cohort study, in Chiang Rai Province in Thailand to determine the role of TST in predicting the development of active tuberculosis (TB) within the following 2 years. Comparison between participants with CD4+ counts <50cells/mm3 to those with CD4+ ≥200cells/mm3 revealed that TST results were less sensitive (7.7% vs 50.0%) and had a lower negative predictive value (73.1% vs 97.3%) in those with a CD4+ count <50cells/mm3. In people with HIV, using a positive TST result as a criterion for initiating IPT inadvertently decreases the benefits of IPT, especially among those with low CD4+ counts.
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Affiliation(s)
- Reiko Miyahara
- Genome Medical Science Project, National Center for Global Health and Medicine, Tokyo, Japan; Department of Human Genetics, The University of Tokyo, Tokyo, Japan.
| | | | | | | | | | - Norio Yamada
- Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan
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14
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Dravid A, Natarajan K, Medisetty M, Gawali R, Mahajan U, Kulkarni M, Saraf C, Ghanekar C, Kore S, Rathod N, Dravid M. Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India. BMC Infect Dis 2019; 19:714. [PMID: 31409289 PMCID: PMC6692924 DOI: 10.1186/s12879-019-4361-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 08/06/2019] [Indexed: 12/27/2022] Open
Abstract
Background Despite rapid scale up of antiretroviral therapy (ART), Tuberculosis (TB) remains the commonest opportunistic infection and cause of death among HIV infected individuals in resource limited settings like India. Incidence of TB in individuals on ART in private healthcare sector in India is infrequently studied. Methods This retrospective cohort study conducted between 1st March 2009 and 1st March 2017 aimed to evaluate rate of incident TB in individuals initiated on ART at 3 private sector ART clinics in Pune, India. Individuals more than 12 years of age with ART duration of atleast 6 months were included. Patients were classified as having prevalent TB if they had a TB episode within the year prior to ART initiation or if they developed TB within 6 months of starting ART. Individuals who were diagnosed with TB after 6 months of starting ART were classified as incident TB cases. A recurrent episode of TB after treatment completion or cure of prevalent TB was also regarded as incident TB. Patients were classified as definitive TB if Mycobacterium tuberculosis was grown in culture from a biological sample or a positive rapid molecular test. Patients were classified as probable TB if there was radiologic evidence of TB in absence of confirmatory culture or PCR. Results 1904 patients with a median duration of follow up on ART of 57 (IQR = 32.0, 84.0) months were included. Of these, 182 developed incident TB (22% definitive TB, 38% recurrent cases). TB incidence at 6–12 months, 13–24 months, 25–60 months and > 60 months of ART was 24.32, 5.46, 2.54 and 0.75 cases per 100 person years respectively. Current time updated CD4 count < 500 cells/mm3 (p < 0.0001), virologic failure on ART (adjusted Hazard Ratio (aHR): 3.05 (95% CI: 2.094, 4.454), p < 0.0001) and receipt of ART without IPT (aHR: 8.24 (95% CI, 3.358, 20.204), p < 0.0001) were associated with higher risk of incident TB. Conclusion Starting ART early in treatment naïve individuals, prompt detection of virologic failure on ART and providing IPT along with ART will be useful in reducing incident TB. Efforts from private sector are crucial in achieving Sustainable Development Goals set by Government of India and attaining the vision of a TB free India.
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Affiliation(s)
- Ameet Dravid
- Department of Medicine, Ruby Hall Clinic, Pune, Maharashtra, India. .,Department of Medicine, Poona Hospital and Research Centre, Pune, Maharashtra, India. .,Department of Medicine, Noble hospital, Pune, Maharashtra, India.
| | - Kartik Natarajan
- Department of Medicine, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | | | - Raviraj Gawali
- Department of Medicine, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Uma Mahajan
- Department of Biostatistics, Precision Diagnostics and Biosciences, Pune, Maharashtra, India
| | - Milind Kulkarni
- Department of Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Chinmay Saraf
- Department of Pathology, Precision Diagnostics and Biosciences, Pune, Maharashtra, India
| | - Charuta Ghanekar
- Department of Microbiology, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Sachin Kore
- Department of Dermatology, Ashwini Sahakari Rugnalaya and Research Centre, Solapur, Maharashtra, India
| | - Niranjan Rathod
- Department of Medicine, Apex hospital, Kolhapur, Maharashtra, India
| | - Mrudula Dravid
- Department of Microbiology, Infectious Disease Clinic, Dhule, Maharashtra, India
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15
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Kim HY, Dowdy DW, Martinson NA, Kerrigan D, Tudor C, Golub J, Bridges JFP, Hanrahan CF. Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment. AIDS Behav 2019; 23:1689-1697. [PMID: 30415430 DOI: 10.1007/s10461-018-2324-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV-positive pregnant women who are initiated on lifelong antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) have lower adherence rates after delivery. We quantified maternal motivation to take preventive therapy before and after delivery among pregnant women newly diagnosed with HIV. We enrolled pregnant women (≥ 18 years) with a recent HIV diagnosis (< 6 months) at 14 public primary health clinics in Matlosana, South Africa and followed them in the postpartum period. Participants received eight choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapy identified through literature reviews and key informant interviews. Data was analyzed using conditional logit regression in the antepartum versus postpartum periods. Coefficients are reported with 95% confidence intervals (CI). Sixty-five women completed surveys both at enrollment and in the postpartum period. All women were already on ART, while 21 (32%) were receiving IPT at enrollment. The mean CD4 count was 436 (± 246) cells/mm3. In the antepartum period, preventing HIV transmission to partners was the most important benefit (coefficients (ß) = 0.87, 95% CI 0.64, 1.11), followed by keeping healthy for family (ß = 0.75, 95% CI 0.52, 0.97). Such prioritization significantly decreased in the postpartum period (p < 0.001). Compared to other motivators, keeping a high CD4 count was least prioritized in the antepartum period (ß = 0.19, 95% CI - 0.04, 0.43) but was most prioritized in the postpartum period (ß = 0.39, 95% CI 0.21, 0.57). These results highlight that messages on family might be particularly salient in the antepartum period, and keeping CD4 count high in the postpartum period. Understanding maternal motivation may help to design targeted health promotion messages to HIV-positive women around the time of delivery.
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Affiliation(s)
- Hae-Young Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Kwazulu-Natal, South Africa
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Deanna Kerrigan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Tudor
- International Council of Nurses, Geneva, Switzerland
| | - Jonathan Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - John F P Bridges
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
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Tram KH, Mwangwa F, Chamie G, Atukunda M, Owaraganise A, Ayieko J, Jain V, Clark TD, Kwarisiima D, Petersen ML, Kamya MR, Charlebois ED, Havlir DV, Marquez C. Predictors of isoniazid preventive therapy completion among HIV-infected patients receiving differentiated and non-differentiated HIV care in rural Uganda. AIDS Care 2019; 32:119-127. [PMID: 31181961 DOI: 10.1080/09540121.2019.1619661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Rates of Isoniazid Preventive Therapy (IPT) completion remain low in programmatic settings in sub-Saharan Africa. Differentiated HIV care models may improve IPT completion by addressing joint barriers to IPT and HIV treatment. However, the impact of differentiated care on IPT completion remains unknown. In a cross-sectional study of people with HIV on antiretroviral therapy in 5 communities in rural Uganda, we compared IPT completion between patients receiving HIV care via a differentiated care model versus a standard HIV care model and assessed multi-level predictors of IPT completion. A total of 103/144 (72%) patients received differentiated care and 85/161 (53%) received standard care completed IPT (p < 0.01). Adjusting for age, gender and community, patients receiving differentiated care had higher odds of completing IPT (aOR: 2.6, 95% CI: 1.5-4.5, p < 0.01). Predictors of IPT completion varied by the care model, and differentiated care modified the positive association between treatment completion and the belief in the efficacy of IPT and the negative association with side-effects. Patients receiving a multi-component differentiated care model had a higher odds of IPT completion than standard care, and the model's impact on health beliefs, social support, and perceived side effects to IPT may underlie this positive association.
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Affiliation(s)
- Khai Hoan Tram
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | | | | | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Vivek Jain
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | - Tamara D Clark
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | - Dalsone Kwarisiima
- Infectious Diseases Research Collaboration, Kampala, Uganda.,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maya L Petersen
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edwin D Charlebois
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA.,Center for AIDS Prevention (CAPS), University of California, San Francisco, CA, USA
| | - Diane V Havlir
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
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- School of Medicine, Stanford University, Stanford, CA, USA
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17
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Geremew D, Endalamaw A, Negash M, Eshetie S, Tessema B. The protective effect of isoniazid preventive therapy on tuberculosis incidence among HIV positive patients receiving ART in Ethiopian settings: a meta-analysis. BMC Infect Dis 2019; 19:405. [PMID: 31077133 DOI: 10.1186/s12879-019-4031-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 04/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Tuberculosis (TB) and HIV makeup a deadly synergy of infectious disease, and the combined effect is apparent in resource limited countries like Ethiopia. Previous studies have demonstrated inconsistent results about the protective effect of isoniazid preventive therapy (IPT) on active TB incidence among HIV positive patients receiving ART. Therefore, the aim of this meta-analysis was, first, to determine the protective effect of IPT on active tuberculosis incidence, and second, to assess the pooled incidence of active TB among HIV positive patients taking ART with and without IPT intervention in Ethiopia. Methods PubMed, Google scholar and Cochran library databases were searched from April 1 to 30, 2018. Two independent authors explored and assessed studies for eligibility, and extracted data based on predefined criteria. Studies that reported TB incidence among HIV positive patients taking ART in Ethiopia with and without IPT concomitant intervention, and with a clear stratified data on the incidence of TB based on the duration of IPT intervention were selected. A random effects model was used to estimate risk ratios and the pooled incident TB with the respective 95% confidence intervals. Results We identified 7 suitable studies in this analysis. Accordingly, IPT reduced the risk of TB incidence by 74%, risk ratio (RR) 0.26 (95% CI; 0.16–0.43%), compared to no IPT group. Moreover, IPT for 12 months reduced incident TB by 91% (RR: 0.09, 95% CI: 0.04 to 0.21), whereas 6 months IPT averted TB incidence by 63% (RR: 0.37, 95% CI: 0.26 to 0.52). The overall pooled incident TB among HIV infected patients receiving ART was 10.30% (95% CI; 7.57–13.02%). Specifically, incident TB among study cohorts with and without IPT was 3.79% (95% CI; 2.03–5.55%) and 16.32% (95% CI; 11.57–21.06%) respectively. Conclusion IPT reduced the risk of incident TB among HIV positive patients receiving ART in Ethiopian settings. Moreover, the duration of IPT intervention has effect on its protective role. Thus, scaling up the isoniazid preventive therapy program and its strict compliance is necessary to avert HIV fueled tuberculosis. Study protocol registration CRD42018090804. Electronic supplementary material The online version of this article (10.1186/s12879-019-4031-2) contains supplementary material, which is available to authorized users.
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Graves SK, Augusto O, Viegas SO, Lederer P, David C, Lee K, Hassane A, Cossa A, Amade S, Peleve S, Zindoga P, Massawo L, Torriani FJ, Nunes EA. Tuberculosis infection risk, preventive therapy care cascade and incidence of tuberculosis disease in healthcare workers at Maputo Central Hospital. BMC Infect Dis 2019; 19:346. [PMID: 31023260 PMCID: PMC6485058 DOI: 10.1186/s12879-019-3966-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mozambican healthcare workers have high rates of latent and active tuberculosis, but occupational screening for tuberculosis is not routine in this setting. Furthermore, the specificity of tuberculin skin testing in this population compared with interferon gamma release assay testing has not been established. METHODS This study was conducted among healthcare workers at Maputo Central Hospital, a public teaching quaternary care hospital in Mozambique. With a cross sectional study design, risk factors for tuberculosis were assessed using multivariable logistic regression. The care cascade is reported for participants who were prescribed six months of isoniazid preventive therapy for HIV or highly reactive testing for latent tuberculosis infection. The agreement of interferon-gamma release assay results with positive tuberculin skin testing was calculated. RESULTS Of 690 screened healthcare workers, three (0.4%) had active tuberculosis and 426 (61.7%) had latent tuberculosis infection. Less education, age 35-49, longer hospital service, and work in the surgery department were associated with increased likelihood of being tuberculosis infected at baseline (p < 0.05). Sex, Bacillus Calmette-Guerin vaccination, HIV, outside tuberculosis contacts, and professional category were not. Three new cases of active tuberculosis developed during the follow-up period, two while on preventive therapy. Among 333 participants offered isoniazid preventive therapy, five stopped due to gastrointestinal side effects and 181 completed treatment. For HIV seropositive individuals, the agreement of interferon gamma release assay positivity with positive tuberculin skin testing was 50% among those with a quantitative skin test result of 5-10 mm, and among those with a skin test result ≥10 mm it was 87.5%. For HIV seronegative individuals, the agreement of interferon gamma release assay positivity with a tuberculin skin test result of 10-14 mm was 63.6%, and for those with a quantitative skin test result ≥15 mm it was 82.2%. CONCLUSIONS There is a high prevalence of tuberculosis infected healthcare workers at Maputo Central Hospital. The surgery department was most heavily affected, suggesting occupational risk. Isoniazid preventive therapy initiation was high and just over half completed therapy. An interferon gamma release assay was useful to discern LTBI from false positives among those with lower quantitative tuberculin skin test results.
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Affiliation(s)
- Susannah K. Graves
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Diego, 9500 Gilman Drive MC 0711, La Jolla, CA 92093-0711 USA
| | - Orvalho Augusto
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Sofia Omar Viegas
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Philip Lederer
- Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Catarina David
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Kristen Lee
- Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Anila Hassane
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Anilsa Cossa
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Salma Amade
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Susete Peleve
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Pereira Zindoga
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Leguesse Massawo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Francesca J. Torriani
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Diego, 9500 Gilman Drive MC 0711, La Jolla, CA 92093-0711 USA
- UC San Diego Infection Prevention and Clinical Epidemiology and TB Control Units at UC San Diego Health, 200 W Arbor Drive MC 8951, San Diego, California 92103 USA
| | - Elizabete A. Nunes
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
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Sabasaba A, Mwambi H, Somi G, Ramadhani A, Mahande MJ. Effect of isoniazid preventive therapy on tuberculosis incidence and associated risk factors among HIV infected adults in Tanzania: a retrospective cohort study. BMC Infect Dis 2019; 19:62. [PMID: 30654753 PMCID: PMC6337848 DOI: 10.1186/s12879-019-3696-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculosis (TB) continues to be the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals in Sub Saharan Africa including Tanzania. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions to reduce the burden of TB among HIV infected persons. However there is limited information about the influence of IPT on TB incidence in Tanzania. This study aimed at ascertaining the effect of IPT on TB incidence and to determine risk factors for TB among HIV positive adults in Dar es Salaam region. Methods A retrospective cohort study was conducted using secondary data of HIV positive adults receiving care and treatment services in Dar es Salaam region from 2011 to 2014. TB incidence rate among HIV positive adults on IPT was compared to those who were not on IPT during the follow up period. Risk factors for incident TB were estimated using multivariate Cox proportional hazards regression model. Results A total of 68,378 HIV positive adults were studied. The median follow up time was 3.4 (IQR = 1.9–3.8) years for patients who ever received IPT and 1.3 (IQR = 0.3–1.3) years among those who never received IPT. A total of 3124 TB cases occurred during 114,926 total person-years of follow up. The overall TB incidence rate was 2.7/100 person-years (95%CI; 2.6–2.8). Patients on IPT had 48% lower TB incidence rate compared to patients who were not on IPT (IRR = 0.52, 95%CI; 0.46–0.59). Factors associated with higher risk for incident TB included; being male (aHR = 1.8, 95% CI; 1.6–2.0), WHO stage III (aHR = 2.7, 95% CI; 2.3–3.3) and IV (aHR = 2.4, 95% CI; 1.9–3.1),being underweight (aHR = 1.7, 95% CI; 1.5–1.9) while overweight (aHR = 0.7, 95% CI; 0.6–0.8), obese (aHR = 0.5, 95% CI; 0.4–0.7), having baseline CD4 cell count between 200 and 350 cells/μl (aHR = 0.7, 95% CI; 0.6–0.8) and CD4 count above 350 cells/μl (aHR = 0.5, 95% CI; 0.4–0.6) were associated with lower risk of developing TB. Conclusion Isoniazid preventive therapy (IPT) has shown to be effective in reducing TB incidence among HIV infected adults in Dar es Salaam. More efforts are needed to increase the provision and coverage of IPT.
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Affiliation(s)
- Amon Sabasaba
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania.
| | - Henry Mwambi
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania.,School of Statistics and Actuarial Sciences, University of Kwazul-Natal, Durban, South Africa
| | - Geoffrey Somi
- Ministry of Health, Community Development, Gender Elderly and Children (MOHCDGEC) - National Aids Control Program, Dar es salaam, Tanzania
| | - Angella Ramadhani
- Ministry of Health, Community Development, Gender Elderly and Children (MOHCDGEC) - National Aids Control Program, Dar es salaam, Tanzania
| | - Michael J Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania
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Shayo GA, Chitama D, Moshiro C, Aboud S, Bakari M, Mugusi F. Cost-Effectiveness of isoniazid preventive therapy among HIV-infected patients clinicaly screened for latent tuberculosis infection in Dar es Salaam, Tanzania: A prospective Cohort study. BMC Public Health 2017; 18:35. [PMID: 28724374 PMCID: PMC5518094 DOI: 10.1186/s12889-017-4597-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 07/14/2017] [Indexed: 01/29/2023] Open
Abstract
Background One of the reasons why Isoniazid preventive therapy (IPT) for Tuberculosis (TB) is not widely used in low income countries is concerns on cost of excluding active TB. We analyzed the cost-effectiveness of IPT provision in Tanzania having ruled out active TB by a symptom-based screening tool. Methods Data on IPT cost-effectiveness was prospectively collected from an observational cohort study of 1283 HIV-infected patients on IPT and 1281 controls; followed up for 24 months. The time horizon for the analysis was 2 years. Number of TB cases prevented and deaths averted were used for effectiveness. A micro costing approach was used from a provider perspective. Cost was estimated on the basis of clinical records, market price or interviews with medical staff. We annualized the cost at a discount of 3%. A univariate sensitivity analysis was done. Results are presented in US$ at an average annual exchange rate for the year 2012 which was Tanzania shillings 1562.4 for 1 US $. Results The number of TB cases prevented was 420/100,000 persons receiving IPT. The number of deaths averted was 979/100,000 persons receiving IPT. Incremental cost due to IPT provision was US$ 170,490. The incremental cost effective ratio was US $ 405.93 per TB case prevented and US $ 174.15 per death averted. These costs were less than 3 times the 768 US $ Gross Domestic Product (GDP) per capita for Tanzania in the year 2014, making IPT provision after ruling out active TB by the symptom-based screening tool cost-effective. The results were robust to changes in laboratory and radiological tests but not to changes in recurrent, personnel, medication and utility costs. Conclusion IPT should be given to HIV-infected patients who screen negative to symptom-based TB screening questionnaire. Its cost-effectiveness supports government policy to integrate IPT to HIV/AIDS care and treatment in the country, given the availability of budget and the capacity of health facilities.
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Affiliation(s)
- Grace A Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Dereck Chitama
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, United Nations road, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, United Nations road, Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly and Children, P.O.Box 9083, Mirambo street, Dar es Salaam, Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Jacobson KB, Niccolai L, Mtungwa N, Moll AP, Shenoi SV. "It's about my life": facilitators of and barriers to isoniazid preventive therapy completion among people living with HIV in rural South Africa. AIDS Care 2017; 29:936-942. [PMID: 28147705 DOI: 10.1080/09540121.2017.1283390] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite the recent rollout of Isoniazid Preventive Therapy (IPT) to prevent TB in people living with HIV in South Africa, adherence and completion rates are low. To explore barriers to IPT completion in rural KwaZulu-Natal, South Africa, we conducted individual semi-structured interviews among 30 HIV patients who had completed or defaulted IPT. Interview transcripts were analyzed according to the framework method of qualitative analysis. Facilitators of IPT completion included knowledge of TB and IPT, accepting one's HIV diagnosis, viewing IPT as similar to antiretroviral therapy, having social support in the community and the clinic, trust in the healthcare system, and desire for health preservation. Barriers included misunderstanding of IPT's preventive role in the absence of symptoms, inefficient health service delivery, ineffective communication with healthcare workers, financial burden of transport to clinic and lost wages, and competing priorities. HIV-related stigma was not identified as a significant barrier to IPT completion, and participants felt confident in their ability to manage stigma, for example by pretending their medications were for unrelated conditions. Completers were more comfortable communicating with health care workers than were defaulters. Efforts to facilitate successful IPT completion must include appropriate counseling and education for individual patients and addressing inefficiencies within the health care system in order to minimize patients' financial and logistical burden. These patient-level and structural changes are necessary for IPT to successfully reduce TB incidence in this resource-limited setting.
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Affiliation(s)
- Karen B Jacobson
- a Department of Medical Education , Icahn School of Medicine at Mount Sinai , New York , USA
| | - Linda Niccolai
- b Department of Epidemiology of Microbial Diseases , Yale University School of Public Health , New Haven , USA
| | - Nonhle Mtungwa
- c Research Department , Philanjalo Care Centre , Tugela Ferry , South Africa
| | - Anthony P Moll
- d Church of Scotland Hospital , Tugela Ferry , South Africa
| | - Sheela V Shenoi
- e Department of Internal Medicine, Section of Infectious Diseases, AIDS Program , Yale University School of Medicine , New Haven , USA
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Hermans SM, Grant AD, Chihota V, Lewis JJ, Vynnycky E, Churchyard GJ, Fielding KL. The timing of tuberculosis after isoniazid preventive therapy among gold miners in South Africa: a prospective cohort study. BMC Med 2016; 14:45. [PMID: 27004413 PMCID: PMC4804575 DOI: 10.1186/s12916-016-0589-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/02/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The durability of isoniazid preventive therapy (IPT) in preventing tuberculosis (TB) is limited in high-prevalence settings. The underlying mechanism (reactivation of persistent latent TB or reinfection) is not known. We aimed to investigate the timing of TB incidence during and after IPT and associated risk factors in a very high TB and HIV-prevalence setting, and to compare the observed rate with a modelled estimate of TB incidence rate after IPT due to reinfection. METHODS In a post-hoc analysis of a cluster-randomized trial of community-wide IPT among South African gold miners, all intervention arm participants that were dispensed IPT for at least one of the intended 9 months were included. An incident TB case was defined as any participant with a positive sputum smear or culture, or with a clinical TB diagnosis assigned by a senior study clinician. Crude TB incidence rates were calculated during and after IPT, overall and by follow-up time. HIV status was not available. Multivariable Cox regression was used to analyse risk factors by follow-up time after IPT. Estimates from a published mathematical model of trial data were used to calculate the average reinfection TB incidence in the first year after IPT. RESULTS Among 18,520 participants (96% male, mean age 41 years, median follow-up 2.1 years), 708 developed TB. The TB incidence rate during the intended IPT period was 1.3/100 person-years (pyrs; 95% confidence interval (CI), 1.0-1.6) and afterwards 2.3/100 pyrs (95% CI, 1.9-2.7). TB incidence increased within 6 months followed by a stable rate over time. There was no evidence for changing risk factors for TB disease over time after miners stopped IPT. The average TB incidence rate attributable to reinfection in the first year was estimated at 1.3/100 pyrs, compared to an observed rate of 2.2/100 pyrs (95% CI, 1.8-2.7). CONCLUSIONS The durability of protection by IPT was lost within 6-12 months in this setting with a high HIV prevalence and a high annual risk of M. tuberculosis infection. The observed rate was higher than the modelled rate, suggesting that reactivation of persistent latent infection played a role in the rapid return to baseline TB incidence.
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Affiliation(s)
- Sabine M. Hermans
- />TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- />Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- />Desmond Tutu HIV Centre, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- />Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alison D. Grant
- />TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- />The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- />School of Nursing & Public Health (Africa Centre for Population Health), University of KwaZulu-Natal, Durban, South Africa
| | - Violet Chihota
- />The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- />Aurum Institute, Johannesburg, South Africa
| | - James J. Lewis
- />TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Emilia Vynnycky
- />TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- />Public Health England, London, UK
| | - Gavin J. Churchyard
- />TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- />The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- />Aurum Institute, Johannesburg, South Africa
- />Advancing Care and Treatment for TB and HIV, MRC Collaborating Centre of Excellence, Johannesburg, South Africa
| | - Katherine L. Fielding
- />TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- />The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Akolo C, Bada F, Okpokoro E, Nwanne O, Iziduh S, Usoroh E, Ali T, Ibeziako V, Oladimeji O, Odo M. Debunking the myths perpetuating low implementation of isoniazid preventive therapy amongst human immunodeficiency virus-infected persons. World J Virol 2015; 4:105-112. [PMID: 25964875 PMCID: PMC4419114 DOI: 10.5501/wjv.v4.i2.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/04/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
Isoniazid preventive therapy (IPT) is the administration of isoniazid (INH) to people with latent tuberculosis (TB) infection (LTBI) to prevent progression to active TB disease. Despite being life-saving for human immunodeficiency virus (HIV)-infected persons who do not have active TB, IPT is poorly implemented globally due to misconceptions shared by healthcare providers and policy makers. However, amongst HIV-infected patients especially those living in resource-limited settings with a high burden of TB, available evidence speaks for IPT: Among HIV-infected persons, active TB- the major contraindication to IPT, can be excluded with symptom screening; chest X-ray and tuberculin skin testing are unreliable and often lead to logistic delays resulting in increased numbers of people with LTBI progressing to active TB; the use of IPT has not been found to increase the risk of the development of INH mono-resistance; IPT is cost-effective and cheaper than the cost of treating cases of active TB that would develop without IPT; ART and IPT have an additive effect on the prevention of TB, and both are safe and beneficial even in children. In order to sustain the recorded gains from ART scale-up and to further reduce TB-related morbidity and mortality, more efforts are needed to scale-up IPT implementation globally.
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Mindachew M, Deribew A, Memiah P, Biadgilign S. Perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings: a qualitative study. Pan Afr Med J 2014; 17:26. [PMID: 24932337 PMCID: PMC4048699 DOI: 10.11604/pamj.2014.17.26.2641] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/21/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction Isoniazid preventive therapy (IPT) reduces the risk of active TB. IPT is a key public health intervention for the prevention of TB among people living with HIV and has been recommended as part of a comprehensive HIV and AIDS care strategy. However, its implementation has been very slow and has been impeded by several barriers. Objective: The Objective of the study is to assess the perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings in Addis Ababa, Ethiopia in 2010. Methods A qualitative study using a semi-structured interviewed guide was used for the in-depth interview. A total of 12 key informants including ART Nurse, counselors and coordinators found in four hospitals were included in the interview. Each session of the in-depth interview was recorded via audio tape and detailed notes. The interview was transcribed verbatim. The data was analyzed manually. Results The findings revealed that poor patient adherence was a major factor; with the following issues cited as the reasons for poor adherence; forgetfulness; lack of understanding of condition and patient non- disclosure of HIV sero-status leading to insubstantial social support; underlying mental health issues resulting in missed or irregular patient appointments; weak patient/healthcare provider relationship due to limited quality interaction; lack of patient information, patient empowerment and proper counseling on IPT; and the deficient reinforcement by health officials and other stakeholders on the significance of IPT medication adherence as a critical for positive health outcomes. Conclusion Uptake of the implementation of IPT is facing a challenge in resource limited settings. This recalled provision of training/capacity building and awareness creation mechanism for the health workers, facilitating disclosure and social support for the patients is recommended.
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Affiliation(s)
- Mesele Mindachew
- Department of General Public Health, College of Public Health and Medical Science, Jimma University, Ethiopia
| | - Amare Deribew
- Department of Epidemiology, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia
| | - Peter Memiah
- University of Maryland School of Medicine-Institute of Human Virology, Baltimore, MD
| | - Sibhatu Biadgilign
- Department of Epidemiology, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia
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Ramos JM, Biru D, Tesfamariam A, Reyes F, Górgolas M. Screening for tuberculosis in family and household contacts in a rural area in Ethiopia over a 20-month period. Int J Mycobacteriol 2013; 2:240-3. [PMID: 26786130 DOI: 10.1016/j.ijmyco.2013.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 10/03/2013] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to describe the experience of the completion of the Tuberculosis (TB) Contact Screening Logbook (TB-CSL). The TB-CSL was retrospectively analyzed from July 2007 until June 2012. During the study period, 122 patients were included in the TB-CSL; however, 17 (13.9%) patients with TB were written in the TB-CSL, but without registering any contacts. Of the 105 TB patients with contacts registered, the family and household contacts were finally performed in 68 index TB patients (55.7% of TB patients). These 68 index TB cases had 299 family and household contacts; the median contact per patient was 4.4 (±1.9). Of the 299 contacts, 160 (53.5%) were screened. The median of those screened per patient was 2.3 (±1.9). Of the 160 family and household contacts screened, 34 (31.3%) of them were children ⩽5years of age. TB was diagnosed after screening in 16 (10.1%) contacts. Isoniazid preventive therapy was prescribed in 22 of 34 (64%) children <5years of age. Alternative methods should be implemented in rural areas to improve TB screening contacts, especially in children under 5years of age.
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Affiliation(s)
- Jose Manuel Ramos
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia; Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Department of Medicine, Miguel Hernández University of Elche, Spain.
| | - Dejere Biru
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia
| | - Abraham Tesfamariam
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia
| | - Francisco Reyes
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia
| | - Miguel Górgolas
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia; Division of Infectious Diseases, Fundación Jiménez Díaz, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Spain
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