Abstract
Background:Isoniazid Preventive Therapy (IPT) has been recommended by WHO/UNAIDS for people living with HIV (PLWH) since 1993; however the uptake of IPT implementation has been very low globally. This study aims to assess the barriers to and motivations for the implementation of IPT for PLWH in upper northern Thailand, an area with a high tuberculosis (TB) and human immunodeficiency virus (HIV) burden.Methods:A survey was carried out via self-administered questionnaires mailed to healthcare workers (HCW) in all 95 public hospitals in the upper northern region of Thailand. A reminding phone call, one month after sending the mail, was made.Results:The response rate from the hospitals was 94% and from the HCW's, 70%. IPT programme was being implemented at only 18 (20%) out of the 89 public hospitals. The main barriers as reported by 144 HCWs working in hospitals without IPT programme, were: (1) unclear direction of national policy (60%), (2) fear of emerging Isoniazid resistant tuberculosis (52%), and (3) fear of poor adherence (30%). The 38 HCWs from hospitals implementing IPT programme, were motivated by (1) knowledge that IPT can prevent TB (63%), (2) the following of national guideline (34%), (3) concern for TB prevention even after the expansion of access to antiretroviral therapy (ART) (32%).Conclusion and Recommendation:To implement an IPT programme for PLWH, giving a clear national policy and straightforward direction are necessary. Furthermore, provision of public health information and updated evidences may enhance HCW's comprehension of benefits and risks of IPT, thus it may increase the IPT programme implementation.
Highlights
TB-human immunodeficiency virus (HIV) co-infection is the leading cause of death among people living with HIV (PLWH), bringing about a persistently high mortality rate across the world (Aung et al, 2013; Au-Yeung et al, 2011; World Health Organization (WHO), 2012)
This study aims to assess the barriers to and motivations for the implementation of Isoniazid Preventive Therapy (IPT) for PLWH in upper northern Thailand, an area with a high tuberculosis (TB) and human immunodeficiency virus (HIV) burden
The main barriers as reported by 144 healthcare workers (HCW) working in hospitals without IPT programme, were: (1) unclear direction of national policy (60%), (2) fear of emerging Isoniazid resistant tuberculosis (52%), and (3) fear of poor adherence (30%)
Summary
TB-HIV co-infection is the leading cause of death among people living with HIV (PLWH), bringing about a persistently high mortality rate across the world (Aung et al, 2013; Au-Yeung et al, 2011; WHO, 2012). Isoniazid Preventive Therapy (IPT) has been recommended by WHO/UNAIDS for people living with HIV (PLWH) since 1993; the uptake of IPT implementation has been very low globally. This study aims to assess the barriers to and motivations for the implementation of IPT for PLWH in upper northern Thailand, an area with a high tuberculosis (TB) and human immunodeficiency virus (HIV) burden. The main barriers as reported by 144 HCWs working in hospitals without IPT programme, were: (1) unclear direction of national policy (60%), (2) fear of emerging Isoniazid resistant tuberculosis (52%), and (3) fear of poor adherence (30%). The 38 HCWs from hospitals implementing IPT programme, were motivated by (1) knowledge that IPT can prevent TB (63%), (2) the following of national guideline (34%), (3) concern for TB prevention even after the expansion of access to antiretroviral therapy (ART) (32%). Provision of public health information and updated evidences may enhance HCW’s comprehension of benefits and risks of IPT, it may increase the IPT programme implementation
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