Keywords
IPT discontinuation; HIV; Tuberculosis; Predictors; Tanzania
Abstract
Background: Tuberculosis disease is a common opportunistic infection in people living with HIV not initiated Isoniazid Preventive Therapy dose. In 2015 WHO recommended at least, 36-months course for significant population benefits towards reducing Tuberculosis infections in the high-risk population, although the minimum recommended is six months dose. Six months dose completion is sub-optimal and enrolled clients in the treatment discontinue within three months following initiation. The time interval after three months following initiation clients have low dose discontinuation. Isoniazid Preventive Therapy discontinuation within three months following initiation is high although is inadequately routine documented at health facility settings in Tanzania. The study determined predictors of Isoniazid Preventive Therapy discontinuation within three months following initiation among People Living with HIV aged 15 and above years in Dar es Salaam region.
Methods: A retrospective cohort study was conducted using secondary data which are routinely collected. Researcher abstracted data from 58 care and treatment clinics in the region. The study recruited clients who screened negative for TB symptoms and initiated IPT from January 2013 to June 2017. Multilevel Modified Poisson regression model with robust standard errors were used to estimate Prevalence Ratios (PR), 95% Confidence Interval (CI) and p-values at 5% significance level for predictors of IPT discontinuation within three months following initiation among HIV infected individuals. Health facility cluster adjusted model was used to estimate the random effects. The covariates that were adjusted in the final model are age, sex, years of Isoniazid Preventive Therapy, health facility ownership, ART status, WHO stage, CD4+ cells/µL and functional status.
Results: A total of 29,382 clients were initiated Isoniazid Preventive Therapy, with 21,808 (74%) female. Overall 11,826 (40.3%) discontinued IPT, decreasing from 57.2% (1,062/1,857) in year 2013 to 22.9% (883/3,856) in year 2017. Adjusted findings and show that clients with CD4+ cells/µL between 100 to 349 +cells/µL had significant higher Isoniazid Preventive Therapy, discontinuation prevalence than those with CD4+
Conclusion: IPT discontinuation is high although was decreasing over time. Significant higher prevalence of IPT discontinuation was seen in PLHIV with CD4+ between 100 to 349 cells/µL. Patients who were not on ART had lower prevalence than baseline group. Therefore, much intervention for reducing IPT discontinuation within three months following initiation in exposed groups are highly needed, although there was decreasing trend as per year increase.
Citation
Robert M, Msuya SE, Mujuni MR, Mahande MJ, Ngocho JS, et al. (2024) Predictors of Isoniazid Preventive Therapy Discontinuation among People Living With HIV Attending Care and Treatment: Analysis of 2013-2017 Routine HIV Data Tanzania. SM J Infect Dis 7: 9.