Factors associated with isoniazid preventive treatment interruption and completion among PLHIV in Gombe Hospital, Uganda, 2017-2019

Emmanuel Ssendikwanawa; Edirisa Juniour Nsubuga; Seungwon Lee; Jane Frances Zalwango; Rokani Joan Bayowa; Amuntuhaire Judith Ssemasaazi; Kivumbi Ronald Muganga; Cherop Adolphus; Rebecca Akunzirwe; Rachel Nante Wangi; Mutebi Ronald Kasoma; Joan N Kalyango; Charles Karamagi; Christine Sekaggya-Wiltshire

doi:10.1016/j.jctube.2023.100349

Factors associated with isoniazid preventive treatment interruption and completion among PLHIV in Gombe Hospital, Uganda, 2017-2019

J Clin Tuberc Other Mycobact Dis. 2023 Jan 24:31:100349. doi: 10.1016/j.jctube.2023.100349. eCollection 2023 May.

Authors

Emmanuel Ssendikwanawa¹, Edirisa Juniour Nsubuga², Seungwon Lee³, Jane Frances Zalwango¹, Rokani Joan Bayowa¹, Amuntuhaire Judith Ssemasaazi¹, Kivumbi Ronald Muganga¹, Cherop Adolphus¹, Rebecca Akunzirwe¹, Rachel Nante Wangi¹, Mutebi Ronald Kasoma¹, Joan N Kalyango¹, Charles Karamagi^{4

5}, Christine Sekaggya-Wiltshire⁵

Affiliations

¹ Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda.
² Ministry of Health, Kampala, Uganda.
³ Department of Neuroscience, University of Pennsylvania, United States of America.
⁴ Child Health Department, College of Health Sciences, Makerere University, Kampala, Uganda.
⁵ Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.

Abstract

Background: Tuberculosis (TB) is the leading cause of death in persons living with HIV (PLHIV). PLHIV carry a disproportionate burden of TB infection with risks 20-37 times greater than HIV-negative populations. While isoniazid preventive treatment (IPT) is regarded as a crucial component of HIV care to prevent active TB, the uptake among PLHIV remains very poor. Studies on the factors associated with IPT interruption and completion among PLHIV in Uganda are scarce. Thus, in Gombe Hospital in Uganda, this study assessed the factors associated with IPT interruption and completion among PLHIV.

Methods: This was a hospital-based cross-sectional study that used both quantitative and qualitative methods of data collection from January 3rd, 2020 to February 28th, 2020. We reviewed the medical records of 686 PLHIV who received IPT at Gombe Hospital from January 1st, 2017 to December 31st, 2019. Binary logistic and modified Poisson regression were used to analyze factors associated with IPT completion and interruption. We conducted 7 key informant interviews and 14 in-depth interviews.

Results: Second-line antiretroviral therapy (AOR = 46, p < 0.001) and age ≥ 45 years (AOR = 0.2, p = 0.040) were significantly associated with IPT interruption, while attending routine ART counseling sessions (APR = 1.5, p < 0.001) and prescription for ≥ 2 months at the start of IPT (APR = 1.1, p = 0.010) were associated with IPT completion. Barriers to IPT completion included pill burden, forgetfulness, poor integration of IPT in HIV healthcare services, and lack of awareness of IPT, while facilitators were easy accessibility of IPT and support from implementing partners.

Conclusions: Side effects and pill burden were the major barriers to the long-term completion of IPT. Supplying ≥ 2 months IPT drugs, using IPT drugs with fewer side effects, and counseling during IPT could improve IPT completion and reduce IPT interruption.

Keywords: Isoniazid preventive treatment; Isoniazid preventive treatment completion; Isoniazid preventive treatment interruption; Persons living with HIV; Tuberculosis; Uganda.