Determinants of isoniazid preventive therapy completion among people living with HIV attending care and treatment clinics from 2013 to 2017 in Dar es Salaam Region, Tanzania. A cross-sectional analytical study

Masanja Robert,Angella Ramadhani,James S Ngocho,Michael J Mahande,Bernard J Ngowi,Isaya Jerry,Veryhel Sambu,Jim Todd,Sia E Msuya,Martin R Mujuni,Werner Maokola

doi:10.1186/s12879-020-04997-6

Abstract

BackgroundTuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least 6 months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor the six-month IPT completion since a suboptimal dose may not protect PLHIV from TB infection. This study determined the six-month IPT completion and factors associated with six-month IPT completion among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania.MethodsSecondary analysis of routine data from PLHIV attending 58 care and treatment clinics in Dar es Salaam region was used. PLHIV, aged 15 years and above, who screened negative for TB symptoms and initiated IPT from January, 2013 to June, 2017 were recruited. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account for health facility random effects in order to estimate adjusted PR (APR) for factors associated with IPT six-month completion.ResultsA total of 29,382 PLHIV were initiated IPT, with 21,808 (74%) female. Overall 17,092 (58%) six-month IPT completion, increasing from 42% (773/1857) in year 2013 to 76% (2929/3856) in 2017. Multilevel multivariable model accounting for health facilities as clusters, showed PLHIV who were not on ART had 46% lower IPT completion compared to those were on ART (APR: 0.54: 95%CI: 0.45–0.64). There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54–0.74) compared to those who did not transfer. PLHIV aged 25–34 years had a 6% lower prevalence of IPT completion as compared to those aged 15 to 24 years (APR:0.94 95%CI:0.89–0.98).ConclusionThe IPT completion rate in PLHIV increased over time, but there was lower IPT completion in PLHIV who transferred from other clinics, who were aged 25 to 34 years and those not on ART. Interventions to support IPT in these groups are urgently needed.

Highlights

Tuberculosis (TB) disease is a common opportunistic infection among people living with Human Immunodeficiency virus (HIV) (PLHIV)
Multilevel multivariable model accounting for health facilities as clusters, showed people living with HIV (PLHIV) who were not on Antiretroviral therapy (ART) had 46% lower isoniazid Preventive Therapy (IPT) completion compared to those were on ART (APR: 0.54: 95%confidence interval (CI): 0.45–0.64)
There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54–0.74) compared to those who did not transfer

Summary

Introduction

Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). Tuberculosis (TB) disease is common among people living with HIV (PLHIV), with the lifetime risk of acquiring disease 20–37 times higher compared to people who are HIV negative [1,2,3,4,5]. Tuberculosis co-infection increases the consequences of the HIV burden and contributes to 30– 40% of deaths among PLHIV in high endemic regions [6,7,8,9]. TB/HIV co-infection is a major public health concern with more than million PLHIV co-infected with TB in the year 2017 [7, 10], and 78% of those conifected with TB living in Africa [7]. The consequences of TB/HIV co-infection is an increase in mortality among PLHIV, with the worldwide estimate of 300,000 deaths among PLHIV co-infected with TB in 2013 and 400,000 in 2017 [3, 7, 8, 11,12,13,14, 16]

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