Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil

Abstract

Background: Tuberculosis is the most common opportunistic infection among HIV-infected patients in Brazil. Brazil's national policy for HIV care recommends screening for latent tuberculosis (TB) and implementing isoniazid preventive therapy (IPT). Objectives: We compared physician adherence to TB screening and other prevention and care policies among HIV primary care clinics in Rio de Janeiro City. Methods: Data on performance of CD4 counts, viral load testing, tuberculin skin testing (TST) and IPT were abstracted from patient charts at 29 HIV clinics in Rio de Janeiro as part of the TB/HIV in Rio (THRio) study. Data on use of pneumocystis jiroveci pneumonia (PCP) prophylaxis were also abstracted from a convenience sample of 150 patient charts at 10 HIV clinics. Comparisons were made between rates of adherence to TB guidelines and other HIV care guidelines. Results: Among the subset of 150 patients with confirmed HIV infection in 2003, 96% had at least one reported CD4 counts result; 93% had at least one viral load result reported; and, PCP prophylaxis was prescribed for 97% of patients with CD4 counts < 200 cells/mm 3 or when clinically indicated. In contrast, 67 patients (45%) had a TST performed (all eligible); and only 11% (17) of eligible patients started IPT. Among 12,027 THRio cohort participants between 2003 and 2005, the mean number of CD4 counts and viral load counts was 2.5 and 1.9, respectively, per patient per year. In contrast, 49% of 8,703 eligible patients in THRio had a TST ever performed and only 53% of eligible patients started IPT. Conclusion: Physicians are substantially more compliant with HIV monitoring and PCP prophylaxis than with TB prophylaxis guidelines. Efforts to improve TB control in HIV patients are badly needed.

Effect of mobile-phone messaging on patient and health-worker knowledge and adherence to the isoniazid preventive therapy guideline in HIV clinics in Southeast, Nigeria

“…This is unlike the public or government-owned hospitals where a majority of workers do not take responsibility as a result of poor monitoring and evaluation systems. The good adherence to IPT guidelines seen in this study correlates with previous studies [ 30 , 34 – 36 ], but does not agree with a study carried out in Brazil and another in Thailand which showed that adherence of health workers to the IPT guideline was poor [ 5 , 37 ].…”

Correlates of adherence and utilization of Isoniazid preventive therapy in HIV patients

“…Physicians were reluctant to initiate or motivate stuff nurses on utilization of IPT which is supported by qualitative study from brazil there was a poor adherence for detection and treatment of latent tuberculosis infection among HIV-infected patients by physicians in Rio de janeiro. 19 Clients' believe for imaginary idea of prevention with a potentially toxic drug, pill burden, prescription only for one month and lack of trust when the supply is inconsistent after initiation for few months is partly consistent with a systematic review of qualitative studies Patient choice in taking treatment is framed by the physiological and psychological impacts of the disease and also by the social and cultural structures in which the person is immersed. [20][21] The strengths of this study; it involved a relatively larger sample size than the other local studies, had included qualitative study method and it tried to look for additional factors affecting adherence to IPT regarding occurrence of side effects and availability of other comprehensive care and support.…”

Tuberculosis is associated with non-tuberculosis-related deaths among HIV/AIDS patients in Rio de Janeiro

“…The application of this specific recommendation is hard to measure, but at least two papers have studied adherence of health professionals to HIV guidelines. 8,24 The results indicate that adherence to HIV guidelines is significantly higher than for TB guidelines, and that they were satisfactorily followed by health care professionals in general.…”

“…In a substudy conducted between September 2003 and September 2005, only 45% of eligible patients underwent a tuberculin skin test and only 11% ever started IPT. 8 High mortality has been reported among HIVinfected patients treated for active TB. 9,10 Deaths among these patients may have a number of causes, depending on the degree of immunosuppression and the availability of adequate anti-tuberculosis treatment and antiretroviral therapy (ART).…”