Isoniazid preventive therapy uptake among people living with HIV and enrolled in care in Butebo district, Uganda

Abstract

Background: Tuberculosis (TB) remains a major public health problem worldwide, especially in developing countries. Despite clear evidence that isoniazid preventive therapy (IPT) can reduce the risk of TB disease among PLHIV, uptake of IPT is low in many resource-limited settings with high TB-burden. Therefore, this study was carried out to determine the level of IPT uptake and its associated factors amongst PLHIV who do not have active TB disease. Methodology: This was a retrospective quantitative study amongst newly diagnosed PLHIV who do not have active TB in the FY 2019/20 and enrolled for ART in HIV/TB Clinics in Butebo district in Uganda. Demographic factors (age, sex, religion, marital status, employment status, education level, area of residence, household density), health facility factors (pre-IPT counselling), community factors (distance from H/C, incurred costs to reach H/C), and IPT drug related factors (IPT adherence, default on IPT, frequency of INH refill, INH stockouts) data were collected from 4 selected health facilities using questionnaire tool. Descriptive statistics was used to generate frequency cross tables. Results: A total of 272 eligible cases were included in the study amongst which 93 (34.2%) achieved IPT uptake. Mean duration (years) between HIV diagnosis and start of IPT was 4.31 (SD ±3.782). IPT Uptake among males 34 (37%) and females 59 (32.8%). Modal age group for IPT Uptakes was 20-35 years. 7 (70%) of the employed took up IPT compared to 86 (32.8%) of the employed. IPT uptake was highest among the married 62 (39.5%). Majority of the uptake cases were Christians of which 75 (35.4%) started IPT. Other factors which affected the rate of IPT Uptake include Education level, residence status, household density, Incurrence of costs to reach H/C, Distance from H/C, and Pre-IPT counselling. IPT completion was 91 (97.8%). All cases with good adherence to IPT adherence completed treatment 84 (100%) compared to 7 (77.8%) among those with poor adherence. Of the cases who defaulted on IPT 4 (66.7%) completed IPT while 87 (100%) of those who did not default completed. All the cases 88 (100%) who had regular INH refill completed IPT compared to 3 (60%) with irregular refill. 91 (97.8%) did not experience INH stock outs and completed IPT. Conclusion: This study showed that IPT Uptake was very low at 34.2%. IPT uptake may be scaled up by addressing the factors affecting IPT Uptake, as well as integrating IPT services in routine HIV care, enhancing supervision and monitoring, simplifying screening procedures, providing free screening, training of health workers, and improving logistical supplies at the health centers. The shortcomings need to be discussed at all levels of management from the Health Center, the District and centrally at the Ministry of Health Tuberculosis Control Program.