Acceptability and adherence to Isoniazid preventive therapy in HIV-infected patients clinically screened for latent tuberculosis in Dar es Salaam, Tanzania

Abstract

BackgroundProper adherence to isoniazid preventive therapy (IPT) may depend upon the results of tuberculosis (TB) screening test and patients’ understanding of their risk of developing active TB. We conducted a study to assess the acceptability, adherence and completion profile of IPT among HIV-infected patients who were clinically screened for latent TB Infection (LTBI).MethodsA multicenter observational study was conducted in Dar es Salaam, Tanzania between February 2012 and March 2014. HIV-infected patients 10 years or older were clinically screened using a validated symptom-based screening tool to rule out active TB. Patients found to have no symptoms in the screening tool were given 300 mg of isoniazid (INH) daily for 6 months. Patients were followed up monthly at the National and Municipal hospital HIV clinics for INH refill and assessment of treatment adherence. Adherence was defined as consumption of 90 % or more of the monthly prescription of INH.ResultsAll 1303 invited patients agreed to participate in the study. Of 1303 invited HIV-infected patients, 1283 (98.5 %) were recruited into the study. Twenty eight (2.2 %) did not complete treatment. Those who did not complete the treatment were exclusively adults aged 18 years or older, p = 0.302. The overall mean (±SD) adherence was 98.9 % (±2.9). Adherence level among children aged <18 years (92.2 %) was significantly lower than adherence level among patients aged 18–29 years (98.3 %), 30–49 years (98.8 %) and ≥ 50 years (98.5), p-value = 0.011. Sex, occupation, socio-economic status, duration of HIV infection, being on antiretroviral drugs (ARV) and duration of ARV use were not associated with adherence.ConclusionIPT is highly accepted by HIV infected patients. Patients demonstrated high level of adherence to IPT. The level of adherence among children was slightly lower than that among adults. IPT non-completers were exclusively adults. Children might need adult supervision in taking IPT.

Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review

“…In many cultures, preventive treatments are not endorsed and the misconception exists that you do not need medicines if you do not feel sick . Even after receiving health education, many caregivers in the studies reviewed were reluctant to take their children in for screening or IPT initiation because they felt they were healthy and asymptomatic . This is a difficult point of understanding to alter.…”

“…Many of the perceptions and attitudes towards IPT are interwoven with the social stigma associated with TB infection and help to perpetuate poor treatment adherence. The strong link between TB and HIV co‐infection complicates this stigma further and many families were reported to have avoided screening and treatment so as to prevent the risk of HIV disclosure to family, friends and neighbours . As one nurse reported from a study in Peru, ‘Young people don't want to come (for treatment) because they say, “People will look down on me or they won't want me to even go near them.” They feel ashamed’ .…”

Infecção latente por tuberculose entre pessoas com HIV/AIDS, fatores associados e progressão para doença ativa em município no Sul do Brasil

“…Ressalta-se que 13 (19,7%) indivíduos com diagnóstico de ILTB evoluíram para TB ativa. Quando a terapia com isoniazida é adotada tem-se a redução substancial das chances de desenvolvimento da doença e do óbito 6,25,26 .…”

“…O diagnóstico da ILTB permite indicar a implantação do tratamento com isoniazida e, consequentemente, reduzir o risco de desenvolvimento da doença ativa, cujo tratamento é mais complexo, oneroso e com chances de prognóstico desfavorável 6,7,8 .…”

Isoniazid Preventive Therapy Completion in the Era of Differentiated HIV Care

“…5 Even where IPT programs are implemented, completion rates in East Africa range between 36–98%. 6–11 Countries in sub-Saharan Africa are scaling up both IPT and differentiated HIV care, but there is little data to guide optimal integration of IPT into differentiated HIV care models.…”