Use of isoniazid preventative therapy in HIV infected paediatric patients at Harare Central Hospital

Abstract

Background: Tuberculosis (TB) is the main cause of mortality in people infected with the Human Immunodeficiency Virus (HIV), accounting for more than a quarter of deaths. Although the World Health Organization (WHO) recommends isoniazid preventive therapy to mitigate the TB epidemic, its uptake has been slow.

Objectives: To determine initiation and completion rates of Isoniazid Preventive Therapy (IPT) in HIV infected paediatric outpatients. The secondary objective was to determine the reasons for non-initiation and non-completion of IPT.

Setting: Harare Central Hospital Paediatric HIV Clinic.

Materials and Methods: A retrospective review of medical records for paediatric HIV infected outpatients was conducted from 1 January 2014 through 31 December 2016. Two focus group discussions with parents/guardians and healthcare practitioners at the hospital were conducted to understand the reasons for non-initiation and non-completion of IPT.

Results: Out of total of 351 patients included in the study, 259 (73.8%) were initiated on IPT. There was a delay in the initiation of IPT in the majority (n= 231, 89.2%) of patients with an average delay in initiation of 10.2 months (SD=6.1). A total of 245 patients (94.6%) completed the 6 months of IPT. The main reasons for non-initiation or non-completion of IPT were drug stock outs and poor documentation of patient consultation visits. No patient developed active TB disease during the course of IPT. The focus group discussions revealed concerns about pill burden, adverse effects, development of resistance to anti-TB drugs, and lack of knowledge on IPT as factors related to non-initiation and non-completion of IPT.

Conclusion: The IPT initiation rate was sub-optimal while the IPT completion rate was relatively high. Uninterrupted supply of isoniazid and pyridoxine in all public healthcare facilities is critical for the successful implementation of the IPT program and for the reduction of TB burden.