Uptake and factors associated with isoniazid preventive therapy use among HIV positive children in Dar-es-salaam.

Abstract

Background: TB is the leading infectious cause of death worldwide ranking above HIV. Having HIV infection is one of the major risk factors for the development of TB infection. Isoniazid preventive therapy (IPT) introduced since 1993 and revised in 1998 has been recommended by WHO to be used for all people living with HIV infection including children in areas with a high prevalence of TB exceeding 30%. The role of IPT is to prevent the progression of latent TB to active TB, prevents re-infection with TB upon exposure to an open case of TB. In Tanzania, IPT started to scale up in 2011, of which to date it is still the treatment of choice for latent TB infection (LTBI). There is limited data on IPT use especially in pediatric age group in Tanzania. Objective: To determine the level of IPT uptake and the factors associated with IPT use among HIV infected children attending CTC clinics in Dar-es-Salaam. Methodology A hospital-based cross-sectional study was conducted in four HIV care and treatment clinics in Dar es Salaam, Muhimbili National Hospital (MNH), Mwananyamala, Temeke and Amana hospitals. The study was carried during the months of October 2019 to January 2020 on 320 HIV positive children aged 1 to 14 years. Standardized structured questionnaire was used to collect data on IPT uptake and other clinical data, and parents/caregivers were interviewed for socio-demographic factors. TB screening was done according to WHO, anthropometric measurements were recorded from the participants' cards. Data was analyzed using SPSS version 25. Continuous variables were analyzed using mean, median, range and interquartile range while categorical variables using frequencies and proportions. Differences in proportion were tested using the Chi-square test or Fisher's exact test. A p-value < 0.05 was considered significant. Logistic regression was used to assess independent factors associated with IPT use. Results: A total of 320 children with a mean age of 9 years (SD=3.6) in four HIV clinics in Dar es Salaam were enrolled in this study. The overall level of IPT uptake was 224/320 (70%), this included 72/320 (22.5%) of those who were currently using IPT and 152/320 (47.5%) who ever used IPT previously. Excellent adherence was found in 57/72 (79.2%). Participants’ age, viral load and caregivers’ education on IPT use showed a significant association with IPT use. Conclusion: Level of IPT uptake in HIV positive children attending four CTC in Dar-es-Salaam is low (70%), which is below the global target of ≥90% for End TB strategy in people living with HIV. Level of adherence of IPT in children is also relatively low 79.2%. Older age 10-14years, a higher HIV viral above 1000 copies/ml and having a care giver who had received education on IPT were predictors of IPT use. To improve the IPT uptake the health care workers in CTC should use these factors to identify children and support children who are likely to have poor uptake.