Abstract
IntroductionDespite high rates of successful treatment TB incidence in South Africa remains high, suggesting ongoing transmission and a large reservoir of latently infected persons. Isoniazid preventive therapy (IPT) is recommended as preventive therapy in HIV-infected persons. However, implementation has been slow, impeded by barriers and challenges including the fear of non-adherence.Objective and MethodsThe aim was to evaluate predictors of IPT non-completion. One hundred and sixty four antiretroviral therapy (ART)-naïve HIV-infected patients with tuberculin skin test ≥5 mm were recruited from Khayelitsha day hospital and followed up monthly. A questionnaire was used to collect demographic information.ResultsThe overall completion rate was 69%. In multivariable analysis, there was a 29% decrease in risk of non-completion for every year after HIV diagnosis (OR 0.81; 95% C.I. 0.68–0.98). Self-reported alcohol drinkers (OR 4.05; 95% C.I. 1.89–9.06) also had a four-fold higher risk of non-completion, with a strong association between alcohol drinkers and smoking (χ2 27.08; p<0.001).ConclusionWe identify patients with a recent HIV diagnosis, in addition to self-reported drinkers and smokers as being at higher risk of non-completion of IPT. The period of time since HIV diagnosis should therefore be taken into account when initiating IPT. Our results also suggest that smokers and alcohol drinkers should be identified and targeted for adherence interventions when implementing IPT on a wider scale.
Highlights
Despite high rates of successful treatment TB incidence in South Africa remains high, suggesting ongoing transmission and a large reservoir of latently infected persons
Baseline Characteristics and Isoniazid preventive therapy (IPT) Completion Rate Of the three hundred and fifty three asymptomatic participants screened, one hundred and sixty four participants identified with LTBI were initiated on IPT (Figure 1)
The World Health Organization (WHO) has identified IPT as one of the main interventions to reduce morbidity and mortality from TB in people living with HIV
Summary
Despite high rates of successful treatment TB incidence in South Africa remains high, suggesting ongoing transmission and a large reservoir of latently infected persons. Sub-Saharan Africa bears the brunt of this burden with the World Health Organization (WHO) Africa region having the highest estimated incidence rate [2] In response to these dual epidemics, the WHO’s STOP TB strategy to reduce the global burden of TB by 2015, recommends collaborative HIV/TB activities including the three ‘‘I’’s for HIV/ TB: Intensified Case-Finding (ICF), Isoniazid Preventive Therapy (IPT), and Infection Control in addition to antiretroviral therapy (ART) [3]. IPT has been shown to significantly reduce the risk of incident TB [4] predominantly in those with positive tuberculin skin test This benefit depends on good adherence to the treatment regime. While ART roll-out has been expanding, implementation of IPT has been slow, impeded by barriers and challenges This lack of implementation is in part due to fear of non-adherence [5]
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