Correlates of adherence and utilization of Isoniazid preventive therapy in HIV patients

Abstract

 Objective: Isoniazid (INH) is given to individuals with latent infection of tuberculosis in order to prevent progression to active disease. It is important to understand factors associated with non-adherence to prophylactic Isoniazid. This study aimed to identify correlates of adherence and utilization of Isoniazid in HIV positive patients and to explore the opinions of patients and health care providers.

Methods: Participants eligible for the study were 403 randomly selected HIV positive individuals taking INH on follow up in Yekatit 12 hospital. Adherence was measured by self-report of INH tablets taken for past 3, 7 and 30 days. In depth interview was also conducted on recruited patients and health professionals.

Results: Adherence to INH was 94% for last 7 days. INH related common side effects were reported by 142 participants (35.2%) and only 53 (13.2%) discontinued. The odds of adherence was 104, 7.7 and 34.8 [95% Confidence Interval (18.7, 582.6), (2.6, 22.9) and (4.4, 272.6)] times higher among those patients who did not have jaundice, skin rash and seizure compared to those who developed, respectively.

Conclusion: The prevalence of adherence to INH in Yekatit 12 hospital was better than other local and African studies and the reasons for poor adherence was strongly associated with occurrence of jaundice, skin rash and seizure. Com­prehensive care and support, sustainable drug supply and evaluation of side effects are recommended. J Microbiol Infect Dis 2015;5(2): 45-50

Key words: Tuberculosis; HIV; adherence, Isoniazid, preventive therapy, side effects

Keywords

• Tuberculosis; HIV; adherence, Isoniazid, preventive therapy, side effects

-

Öz

Amaç: Latent tüberküloz enfeksiyonu olan bireylere aktif hastalığın ilerlemesini önlemek için İzoniyazid (INH) profilaksisi verilir. Uyumsuzluk ile ilişkili faktörleri anlamak profilaksi başarısı için önemlidir. Bu çalışmada HIV pozitif hastalarda uyuma ilişkin faktörleri tespit etmek, hastaların ve sağlık hizmeti sunucularının görüşlerini keşfetmek hedeflendi.Yöntemler: Çalışmaya Yekatit 12 hastanesinde takip edilen uygun 403 rastgele seçilmiş HIV pozitif ve INH profilaksisi alan hasta dahil edildi. Uyum, hastaların son 3, 7 ve 30 günde aldıkları INH tabletlerini öz-bildirim metodu ile bildirmeleri ile ölçüldü. Hastalar ve sağlık profesyonelleriyle derinlemesine görüşmeler yapıldı.Bulgular: INH uyumu son yedi gün için % 94 idi. INH ilgili ortak yan etkiler 142 katılımcı (% 35,2) tarafından bildirildi ve sadece 53 (% 13,2) olguda tedavi kesildi. Sarılık, deri döküntüsü ve nöbet gelişmeyen hastalarda sırasıyla 104, 7,7 ve 34,8 [% 95 Güven Aralığı (18,7-582,6), (2,6-22,9) ve (4,4-272,6)] kat fazla uyum olduğu saptandı.Sonuç: Yekatit 12 hastanesinde INH uyum sıklığı diğer yerel ve Afrika çalışmalarına göre daha iyidir ve kötü uyum nedenleri içinde ciddi sarılık görülmesi, deri döküntüsü ve havale gelişimi bulunmaktadır. Kapsamlı bakım ve destek, sürdürülebilir ilaç temini ve yan etkilerin değerlendirilmesi önerilir

Anahtar Kelimeler

• Tüberküloz, HIV, uyum, Isoniazid, koruyucu tedavi, yan etkiler

References

1. WHO, 2012, Global Tuberculosis Report: 8-12. ww.who.int/tb/
2. publications/factsheet_global.pdf
3. WHO, 2012, policy on collaborative TB/HIV activities: 15-18.
4. http://whqlibdoc.who.int/publications/2012/9789241503006_eng.pdf
5. WHO, 2011, Intensified TB case finding and IPT for PLHIV inresource constrained settings: 5-7. http://whqlibdoc.who.int/ publications/2011/9789241500708_eng.pdf
6. Isoniazid Preventive Therapy for the Prevention of Tuberculosis
7. in People Living with HIV/AIDS, 2011, the science of improving lives: 8-11. ww.who.int/hiv/pub/tb/9789241500708 50 Getachew Y & Mekonnen W. Isoniazid preventive therapy in HIV patients J Microbiol Infect Dis www.jmidonline.org Vol 5, No 2, June 2015
8. Churchyard GJ, Scano F, Grant AD, Chaisson RE. Tuberculosis

9. preventive therapy in the era of HIV infection: overview and research priorities. J Infect Dis 2007;196 Suppl 1: S52-62.
10. Getahun H, Kittikraisak W, Heilig CM, et al. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med 2011; 8:e1000391.
11. Balcells ME, Thomas SL, Godfrey-Faussett P, Grant AD. Isoniazid
12. preventive therapy and risk for resistant tuberculosis. Emerg Infect Dis 2006;12:744-751.
13. Sculier D, Getahun H, Lienhardt C. Improving the prevention, diagnosis and treatment of TB among people living with HIV: the role of operational research. J Int AIDS Soc 2011;14: S1-S5.
14. WHO, 2012 Tuberculosis profile, Ethiopia: 8-9. www.who.int/ countries/eth
15. Guidelines for clinical and programatic TB, Leprosy and TB/
16. HIV, 2012 Ethiopia:13-15. www.etharc.org/resources/download/finish/33/709
17. Central Statistical Agency Addis Ababa EIIC, 2012, Maryland, USA EDHS: 312-314.
18. Mindachew M, Deribew A, Tessema F, Biadgilign S. Predictors of adherence to isoniazid preventive therapy among HIV positive adults in Addis Ababa, Ethiopia. BMC Public Health 2011;11:916.
19. Deborah A. Gust1 BM, Unami Mathebula, Risk Factors for Non-Adherence and Loss to Follow-Up ina Three-Year Clinical Trial in Botswana. PloS One 2011;6:5-7.
20. Rowe KA, Makhubele B, Hargreaves JR, et al. Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings? Int J Tuberc Lung Dis. 2005;9:263-269.
21. Aisu T, Raviglione MC, van Praag E, et al. Preventive chemotherapy
22. for HIV-associated tuberculosis in Uganda: an operational assessment at a voluntary counselling and testing centre. AIDS 1995;9:267-273.
23. Hiransuthikul N, Nelson KE, Hiransuthikul P, et al. INH preventive
24. therapy among adult HIV-infected patients in Thailand. Int J Tuberc Lung Dis 2005;9:270-275.
25. Munseri PJ, Talbot EA, Mtei L, Fordham von Reyn C. Completion of isoniazid preventive therapy among HIV-infected patients in Tanzania. Int J Tuberc Lung Dis 2008;12:1037-1041.
26. Samandari T1, Agizew TB, Nyirenda S, et al. 6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomised, doubleblind, placebo-controlled trial. Lancet 2011;377:1588-1598.
27. Saraceni V, Pacheco AG, Golub JE, et al. Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil. Braz J Infect Dis 2011;15:249-252.
28. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999;47:555-567.
29. Munro SA, Lewin SA, Smith HJ, et al. Patient adherence to tuberculosis treatment: a systematic review of qualitative research.
30. PLoS Med 2007;4: e238.