Provider barriers to the uptake of isoniazid preventive therapy among people living with HIV in Ethiopia

Abstract

SETTING: Sixty-seven government health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services across Ethiopia. OBJECTIVE:To examine clinician barriers to implementing isoniazid preventive therapy (IPT) among people living with HIV. DESIGN:A cross-sectional study to evaluate the provider-related factors associated with high IPT coverage at the facility level. RESULTS:On bivariate analysis, the odds of high IPT implementation were lower when clinicians felt patients were negatively affected by the side effects of IPT (OR 0.18, 95%CI 0.04-0.81) and perceived that IPT increased multidrug-resistant TB (MDR-TB) rates (OR 0.66,95%CI 0.44-0.98). The presence of IPT guidelines on site (OR 2.93, 95%CI 1.10-7.77) and TB-HIV training (OR 3.08, 95%CI 1.11-8.53) had a positive relationship with high IPT uptake. In the multivariate model, clinician's perception that active TB was difficult to rule out had a negative association with a high IPT rate (OR 0.93; 95%CI 0.90-0.95). CONCLUSIONS:Clinician impression that ruling out active TB among HIV patients is difficult was found to be a significant barrier to IPT uptake. Continued advancement of IPT relies greatly on improving the ability of providers to determine IPT eligibility and more confidently care for patients on IPT. Improved clinician support and training as well as development of new TB diagnostic technologies could impact IPT utilization among providers.

Isoniazid preventive therapy: Uptake, incidence of tuberculosis and survival among people living with HIV in Bulawayo, Zimbabwe

“…Finally, our study results also show that the 4 year survival of PLHIV on ART and IPT was better than those who were not initiated on IPT. This is in line with other studies from Africa that have shown that provision of IPT along with ART not only prevents TB, but also has other survival benefits depending upon the community settings in which IPT services are implemented [9, 10, 19, 30, 32]. We could not investigate whether this is due to increased protection against TB disease or due to some other pathway in our study due to the small sample size (zero events in the IPT initiated group).…”

Mixed methods systematic review and metasummary about barriers and facilitators for the implementation of cotrimoxazole and isoniazid – preventive therapies for people living with HIV

“…Countries were disproportionally represented. The majority of studies were conducted in South Africa (n = 11) [37, 42, 47, 50-52, 54, 63-65, 67], Uganda (n = 9) [31-33, 38-40, 44, 56, 66], Tanzania (n = 5) [15,35,36,47,60], Kenya (n = 4) [45,47,49,68], Zimbabwe (n = 3) [33,34,47], Ethiopia (n = 3) [47,53,58], and Nigeria (n = 3) [43,47,57]. Another fifteen countries were represented in only one or two studies.…”

“…Some studies were conducted in multiple contexts. Patients (n = 24) [31, 32, 35, 36, 38, 43, 44, 46, 48-52, 54, 55, 58-66], health providers (n = 14) [14,15,36,38,39,45,46,51,53,54,62,63,67,68], and health facilities (n = 14) [15, 33, 36, 37, 39-42, 44, 45, 49, 56, 57, 67] were the study subjects of interest most frequently represented in this review, with at least one of the three study groups included in thirty-eight studies (95%). Few studies included other study subjects, explicitly caregivers [15,34], community members [38], other stakeholders [14,45,46,56], districts [38], and countries [47].…”

“…For example, health providers interviewed in rural India believed that side effects were an important reason for noncompletion of IPT [62]. Although health providers believed that IPT was important for PLHIV [53], due to side effects and contraindications (e.g. active liver disease, history of adverse reactions), sometimes the therapy was not prescribed [53,67].…”

“…Although health providers believed that IPT was important for PLHIV [53], due to side effects and contraindications (e.g. active liver disease, history of adverse reactions), sometimes the therapy was not prescribed [53,67].…”