Implementation of isoniazid preventive therapy among people living with HIV in Northwestern Nigeria: Completion rate and predictive factors

Abstract

Background: Despite proven benefits of isoniazid preventive therapy (IPT) for people living with HIV (PLHIV), its implementation remains limited in low-resource settings. There are also programmatic concerns of the completion rate of IPT particularly when full integration with other HIV services has not been achieved. Aim: The aim of this study was to determine the completion rate of IPT and predictive factors among PLHIV attending six government hospitals in Kebbi state, Northern Nigeria. Methods: This was a retrospective cohort study of program data spanning a 5-year period (December 2010–June 2016). Data were collected between January 2017 and June 2017. Results: A total of 1,134 IPT patients were enrolled of whom 740 (65.3%) were female. The mean age was 40.3 ± 3.7 years. Four hundred and fifty-four (40%) of those who initiated IPT completed the 6-month course. Of the 680 (60%) IPT noncompleters, 117 (17.2%) were lost to follow-up by month 1, 305 (44.9%) by month 2, 156 (22.9%) by month 3, 48 (7.1%) by month 4, and 54 (7.9%) by month 5. Being initiated on IPT by a pharmacist (adjusted odds ratio [aOR]: 23.7, 95% confidence interval [CI]: 16.5–33.9) and receiving ≤2 tuberculosis screening evaluation during IPT period (aOR: 0.58, 95% CI: 0.43–0.78) were associated with a higher and lower risk of completing IPT, respectively, whereas age, sex, and anti-retroviral therapy (ART) status were not significantly associated. Conclusion: IPT completion rate among PLHIV is relatively low, highlighting the need to strengthen IPT rollout in public health facilities in Nigeria. Pharmacy-led IPT adherence education and regular clinical evaluation may improve IPT completion rates, along with synchronizing and prepackaging IPT and ART resupplies for PLHIV.

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

“…Dispense of IPT and ART in separate lines [50] and the lacking synchronization of IPT with other HIV clinic appointments [43] added to patients' waiting time and clinic visits. A qualitative study explored women's ability to maintain their babies on CPT.…”

“…Additional funds needed for employment of health providers [14,56], commodities and lab facilities [56]. Strengthen health provider capacity and knowledge • Additional employment & shifting tasks to lower cadre to scale up HIV care and PT [15,32,38,[41][42][43][44]].…”

“…-Ensuring a reasonable patient-provider ratio [51], hiring personnel dedicated to IPT related activities [68]. -Involving nurses [41], lay counsellors [42], pharmacists [43], social-and community workers [44], as well as PLHIV [32,38]…”

“…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.…”

“…ethnography, phenomenology) [31,34,36,38,40,46,51,54,56,62,63]. Quantitative non-randomized studies frequently failed to address whether the intervention or exposure occurred during the study period as intended [41,43,[58][59][60]66]. Some studies also missed to provide reasons why certain eligible individuals chose not to participate [55,60,65].…”