Factors influencing the implementation of isoniazid preventive therapy for people living with HIV in care and treatment centers in Songea municipality.

Abstract

Background: Isoniazid Preventive Therapy (IPT) for people living with HIV/AIDS (PLHIV) is crucial and essential public health intervention in developing countries with high TB and HIV burden. Despite available evidence that IPT is efficacious and the existence of the WHO recommendation since 1998, its implementation is still low in many countries. In Tanzania little is known regarding factors influencing the implementation of IPT for PLHIV.

Broad Objective: This study aimed at exploring factors influencing the implementation of Isoniazid Preventive Therapy for PLHIV in Care and Treatment Centres (CTCs) in Songea municipality.

Materials and Methods: To explore factors influencing the implementation of Isoniazid Preventive Therapy, a cross sectional descriptive study design using both quantitative and qualitative approaches of data collection was employed. The quantitative part aimed to determine IPT coverage of the municipality while the qualitative part aimed to explore factors influencing the implementation of IPT for PLHIV in CTCs in Songea municipality. The study participants for quantitative part included all PLHIV registered in CTCs of the selected health care facilities from January 2015 to January 2017. The qualitative part involved health care providers who were working in the five selected CTCs and adults PLHIV who were provided IPT in the five selected CTCs in Songea municipality. The quantitative data was collected by conducting review of patients’ records using structured data collection form while the qualitative data was collected by conducting in-depth interviews and observations using in-depth interview guides and observation checklist respectively. Quantitative data was analyzed using SPSS for windows version 20 statistical software. Descriptive statistics (frequencies and percentage) were employed and data were visualized using tables and bar graphs. All interviews were audio-recorded and analyzed using thematic analysis approach. Data was collected between late July and early August 2017.

Results: Twenty one participants participated in the qualitative study. Of these 13 were health care providers and 8 were patients. Overall Isoniazid preventive therapy coverage of the municipal was estimated to be 45%. Insufficient drug supply and drug stock out, shortage of staff, lack of service privacy, long waiting time, drug side effects, pill burden, distance from health care facility, cost of transport, and forgetting drug collection date were reported as the main barriers in the implementation of IPT. Availability of IPT training, regular supportive supervision, collaboration between TB and HIV programs, good provider-client communication, availability of IPT guidelines, patient registers, Information Education and Communication (IEC) materials, availability of TB Screening Questionnaires, patients’ knowledge of IPT and lack of stigma were identified by health care providers and patients as the main enablers/facilitating factors in the implementation of IPT.

Conclusion: Implementation of Isoniazid preventive therapy in Songea municipality, Tanzania had low coverage. Health managers, drug suppliers and partners working in HIV and tuberculosis programs should be committed to ensure sufficient and an uninterrupted supply of Isoniazid and pyridoxine and full scale implementation of Isoniazid preventive therapy to eligible PLHIV.