Outcomes of Isoniazid Preventive Therapy among people living with HIV in Kenya: A retrospective study of routine health care data

Abstract

15Introduction: Isoniazid preventive therapy (IPT) taken by People Living with HIV (PLHIV) protects 16 against tuberculosis (TB). Despite its recommendation, there is scarcity of data on the uptake of 17 IPT among PLHIV and factors associated with treatment outcomes. We aimed to determine the 18 proportion of PLHIV initiated on IPT, IPT treatment outcomes and screening for TB during and 19 after IPT. 20Methods: A retrospective cohort study of a representative sample of PLHIV initiated on IPT 21 between July 2015 and June 2018 in Kenya. We abstracted information on socio-demographic, 22TB screening practices, IPT initiation, follow up, and outcomes from health facilities' patient 23 record cards, IPT cards and IPT registers. Further, we assessed baseline characteristics as 24 potential correlates of developing TB during and after treatment and IPT completion using 25 multivariable logistic regression. 26 Results: We enrolled 138,442 PLHIV into ART during the study period and initiated 95,431 27 (68.9%) into IPT. Abstracted files for 4708 patients initiated on IPT, out of which 3891(82.6%) 28 had IPT treatment outcomes documented, 4356(92.5%) had ever been screened for TB at every 29 clinic visit and 4,243(90.1%) had documentation of TB screening on the IPT tool before IPT Page | ii 30 initiation. 3712(95.4%) of patients with documented IPT treatment outcomes completed their 31 treatment. 42(0.89%) of the abstracted patients developed active TB ,16(38.1%) during and 32 26(61.9%) after completing IPT. Follow up for TB at 6-month post-IPT completion was done for 33 2729(73.5%) of patients with IPT treatment outcomes. Sex, Viral load suppression and clinic 34 type were associated with TB development (p<0.05). Levels 4, 5, FBO, and private facilities 35and IPT prescription practices were associated with IPT completion (p<0.05). 36Conclusion: Two-thirds of PLHIV were initiated on IPT, with a high completion rate. TB screening 37 practices were better during IPT than after completion. Development of TB during and after IPT 38 emphasises need for keen follow up.