High completion rates of isoniazid preventive therapy among persons living with HIV in Swaziland

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The World Health Organization recommends isoniazid preventive therapy (IPT) to treat tuberculous infection in high-risk populations, such as persons living with human immunodeficiency virus (PLHIV) and children aged ,5 years who are close contacts of patients with infectious tuberculosis (TB). The benefits of IPT in these populations have been well documented in the literature.

Despite its proven efficacy, uptake of IPT to reduce future TB disease has been poor in most high TB burden countries. Globally, fewer than 1 million PLHIV newly enrolled in HIV care were reported to have been treated with IPT in 2015.5 Among the 16 high TB or TB-HIV burden countries that reported IPT data, treatment coverage ranged from 2% to 79%. Only 7% of eligible child contacts started preventive therapy in 2015.5 Even when IPT has been initiated, treatment completion rates have typically been low, in the 40–50% range.

In 2011, Swaziland’s Ministry of Health endorsed IPT to treat tuberculous infection in contacts aged ,5 years and in PLHIV. However, in 2014, fewer than 10% of eligible patients received IPT and only 32% of these had documented completion. Programmatic concerns about medication costs, the supply chain and human resources to ensure treatment completion have been raised as significant barriers. Furthermore, as uptake of IPT increases, methods to appropriately shift some tasks of patient management and medication dispensing will be needed to minimize increases in the burden for both patients and health care providers through increased visits and monitoring. Because the optimal model for IPT delivery is not known, we studied IPT delivery models based on patient preference to improve treatment outcomes.

 

Publication Date 
November 2017
Authors 
L. V. Adams, N. Mahlalela, E. A. Talbot, M. Pasipamire, S. Ginindza, M. Calnan, S. Haumba
Resource Type 
Peer-reviewed Journal Articles
Regions/ Countries 
Language 
English
French