Determinants of isoniazid preventive therapy uptake among children living with HIV in Njombe, Tanzania

Abstract

Introduction: Tuberculosis (TB) is among the leading causes of ill-health and deaths in all age groups worldwide. Isoniazid Preventive Therapy (IPT) is proven public health intervention which reduces the risk of developing active TB among people living with HIV. Njombe has highest prevalence of HIV in all age group in the country and is among the five regions with lowest uptake IPT. Despite evidence that IPT is safe and effective, there is limited data on its uptake and associated factors among children living with HIV (CLHIV) aged below 10 years. Objective: Thus, this study aimed to determine IPT uptake, completion and factors associated with IPT uptake among CLHIV aged 1 to < 10 years in Njombe Town Council (TC). Methodology: A facility based cross-sectional study with quantitative approach was conducted in Njombe from 28th May to 3rd July. The study recruited 423 pair of caregiver and children living with HIV aged 1 to < 10 years in Njombe TC using stratified random sampling technique. Data on caregiver related factors were collected using an interviewer-administered questionnaire and data abstraction form to capture information on IPT uptake and completion from child’s medical file. Data were entered and analyzed using SPSS. Descriptive statistics were used to generate frequency table and figures. Pearson Chi-square, and multivariate analysis using Modified Poisson regression with robust standard errors were performed to obtain prevalence ratios with their corresponding Confidence Interval (CI); significance was set at p < 0.05. Results: Most children (73.5%) were aged between 5 – 9 and half of children (53.9%) were female. Most of the caregiver were female (88.2%), median age 34 (Range,18,61) years and 68.3% were biological mothers of the children. Out of 423, 273(64.5%) children were ever on IPT (Uptake of 64.5%). Out of 273 who were initiated, 57 (20.9%) were still on medication at time of the study and the remaining 216 (79.1%) had received IPT six months prior. Out of 216, 142 (65.7%) had documented evidence of 6-month course of IPT completion. Child factors associated with IPT uptake were children aged 5 – 9 years (adjusted Prevalence Ratio (aPR)=1.9, p < 0.001) and multi-month visit (aPR=1.4, p < 0.001). Caregiver-related factors associated with IPT uptake among their children were caregiver’s medical history of TB infection (aPR=1.17, p=0.022) and caregiver who has never been on IPT (aPR= 0.57, p < 0.001). Conclusion: Study has shown the sub-optimal uptake and 6-month course of IPT completion. Furthermore, the study has revealed the determinants of IPT uptake to be children aged 5-9 years, multi-months visiting schedule, history of TB infection and medical history of IPT use among their caregivers. Recommendations: More interventions are needed to promote uptake of IPT in order to achieve its optimal benefits. More studies are required to explore on the barriers of IPT completion and system-related and Provider-related barriers that may hinder uptake among children.