Integrating isoniazid preventive therapy into the fast-track HIV treatment model in urban Zambia: A proof-of -concept pilot project

Mpande Mukumbwa-Mwenechanya; Muhau Mubiana; Paul Somwe; Khozya Zyambo; Maureen Simwenda; Nancy Zongwe; Estella Kalunkumya; Linah Kampilimba Mwango; Miriam Rabkin; Felton Mpesela; Fred Chungu; Felix Mwanza; Peter Preko; Carolyn Bolton-Moore; Samuel Bosomprah; Anjali Sharma; Khunga Morton; Prisca Kasonde; Lloyd Mulenga; Patrick Lingu; Priscilla Lumano Mulenga

doi:10.1371/journal.pgph.0000909

Integrating isoniazid preventive therapy into the fast-track HIV treatment model in urban Zambia: A proof-of -concept pilot project

PLOS Glob Public Health. 2023 Mar 8;3(3):e0000909. doi: 10.1371/journal.pgph.0000909. eCollection 2023.

Authors

Mpande Mukumbwa-Mwenechanya¹, Muhau Mubiana¹, Paul Somwe¹, Khozya Zyambo², Maureen Simwenda³, Nancy Zongwe², Estella Kalunkumya¹, Linah Kampilimba Mwango⁴, Miriam Rabkin^{5

6}, Felton Mpesela⁷, Fred Chungu⁸, Felix Mwanza⁹, Peter Preko¹⁰, Carolyn Bolton-Moore^{1

11}, Samuel Bosomprah^{1

12}, Anjali Sharma¹, Khunga Morton², Prisca Kasonde¹³, Lloyd Mulenga², Patrick Lingu², Priscilla Lumano Mulenga²

Affiliations

¹ Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
² Ministry of Health, Lusaka, Zambia.
³ JSI USAID SAFE, Lusaka, Zambia.
⁴ CIHEB, Lusaka, Zambia.
⁵ ICAP at Columbia University and Departments of Medicine & Epidemiology, New York, New York, United States of America.
⁶ Columbia University Mailman School of Public Health, New York, New York, United States of America.
⁷ Clinton Health Access, Lusaka, Zambia.
⁸ Network of Zambian People Living with HIV, Lusaka, Zambia.
⁹ Treatment Advocacy and Literacy Campaign, Lusaka, Zambia.
¹⁰ ICAP at Columbia University, Mbabane, Eswatini.
¹¹ University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
¹² Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
¹³ ICAP at Columbia University, Lusaka, Zambia.

Abstract

Most people living with HIV (PLHIV) established on treatment in Zambia receive multi-month prescribing and dispensing (MMSD) antiretroviral therapy (ART) and are enrolled in less-intensive differentiated service delivery (DSD) models such as Fast Track (FT), where clients collect ART every 3-6 months and make clinical visits every 6 months. In 2019, Zambia introduced Isoniazid Preventive Therapy (IPT) with scheduled visits at 2 weeks and 1, 3, and 6 months. Asynchronous IPT and HIV appointment schedules were inconvenient and not client centered. In response, we piloted integrated MMSD/IPT in FT HIV treatment model. We implemented and evaluated a proof-of-concept project at one purposively selected high-volume facility in Lusaka, Zambia between July 2019 and May 2020. We sensitized stakeholders, adapted training materials, standard operating procedures, and screened adults in FT for TB as per national guidelines. Participants received structured TB/IPT education, 6-month supply of isoniazid and ART, aligned 6th month IPT/MMSD clinic appointment, and phone appointments at 2 weeks and months 1-5 following IPT initiation. We used descriptive statistics to characterize IPT completion rates, phone appointment keeping, side effect frequency and Fisher's exact test to determine variation by participant characteristics. Key lessons learned were synthesized from monthly meeting notes. 1,167 clients were screened with 818 (70.1%) enrolled, two thirds (66%) were female and median age 42 years. 738 (90.2%) completed 6-month IPT course and 66 (8.1%) reported IPT-related side effects. 539 clients (65.9%) attended all 7 telephone appointments. There were insignificant differences of outcomes by age or sex. Lessons learnt included promoting project ownership, client empowerment, securing supply chain, adapting existing processes, and cultivating collaborative structured learning. Integrating multi-month dispensing and telephone follow up of IPT into the FT HIV treatment model is a promising approach to scaling-up TB preventive treatment among PLHIV, although limited by barriers to consistent phone access.

Copyright: © 2023 Mukumbwa-Mwenechanya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported in part, by the Bill & Melinda Gates Foundation [grant number OPP1152764]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Furthermore, none of the authors received a salary from the funders.