TITLE:
Initiation of Isoniazid Prophylactic Therapy among Newly Diagnosed HIV-Positive Persons in Three High HIV-Burden Districts of South Africa
AUTHORS:
H. N. Fomundam, A. R. Tesfay, S. A. Mushipe, H. T. Nyambi, A. Larsen, M. Cheyip, G. Aynalem, A. K. Wutoh
KEYWORDS:
Isoniazid Prophylaxis Therapy, TB, HIV
JOURNAL NAME:
World Journal of AIDS,
Vol.10 No.2,
May
15,
2020
ABSTRACT: Background: South Africa is experiencing the worst HIV-driven tuberculosis (TB)
epidemic in the world. More than 300,000 new cases of active TB are reported in
the country each year with 60% co-infected with HIV. Isoniazid preventive
therapy (IPT) is a key public health intervention for the prevention of TB
among people living with HIV (PLHIV) and is recommended as part of a
comprehensive HIV and AIDS care strategy. However, program data suggests that
coverage of IPT service to be very low. This study aims to assess IPT initiation rate among newly
diagnosed HIV-positive persons in three high HIV-burden districts of South
Africa. Methods: A cross-sectional study was conducted using routine
data generated from pre-ART and ART programs in 35 purposively selected primary
health care (PHC) clinics in South Africa. The facilities were selected from
three high HIV-burden districts with a mix of urban and rural settings. TB
screening and IPT initiation status was assessed within a window period of
one-year post HIV diagnosis. Initiation rate of IPT services among newly
diagnosed HIV-positive persons was assessed. The chi-squared test was used to
determine whether there was a significant difference in the proportion of newly
diagnosed HIV-positive persons who were initiated on IPT by sex, age group,
pregnancy status, health facility, district and location of facility. Results: We identified 12,413 newly diagnosed HIV patients aged 12-years-old and above
between June 1, 2014 and March 31, 2015. TB screening was not conducted among 33%
of newly diagnosed HIV-positive persons to rule out or confirm the presence of
active TB. IPT was initiated in 42.2% of known IPT-eligible HIV-positive
persons. Initiation of IPT services was lower in younger patients aged 12 to
20-years-old compared to older patients. The proportion of pregnant women who
were initiated on IPT was higher compared to the proportion in non-pregnant
women (51.0% and 40.1% respectively; P Conclusion: This analysis shows that initiation rate of
IPT services among newly diagnosed HIV positive persons was low in the 35
participating facilities during the period under investigation. There was
variability in IPT initiation rates across the facilities included in this
study and among different sub-groups of the study sample. This study has
identified specific population groups and geographic settings that should be
targeted by programs to improve IPT services. There is a need to identify
factors that contributed to the low initiation rate of IPT services among young
HIV positive persons, women with unrecorded pregnancy status and in facilities
located in inner city of Johannesburg. Customized interventions tailored to the
specific needs of facilities and population groups should be instituted to strengthen
uptake of IPT services.