USE OF ISONIAZID PROPHYLAXIS THERAPY IN HIV CLIENTS: CHALLENGES AND PROSPECTS

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USE OF ISONIAZID PROPHYLAXIS THERAPY IN HIV CLIENTS: CHALLENGES AND PROSPECTS

ABSTRACT

The Human Immunodeficiency virus / Acquired immune-deficiency syndrome (HIV/AIDs) is a very serious disease and pandemic. There have been series of interventions to combat the disease and these include, Prevention of mother to child transmission, HIV counseling and testing, treatment of HIV/AIDs with antiretroviral drugs and the three I’s which include Intensive case search, Infection control and Isoniazid preventive therapy (IPT). There appears to be paucity of information on the IPT in our environment and it is therefore necessary to find out how the IPT has been implemented in this part of the world. Objective: to determine the number of Cases of HIV placed on IPT. Methodology: This is a cross sectional study in which the HIV patients who were placed on the IPT were identified and followed up. 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. The situational analysis was carried out to identify those already placed on IPT. The next stage was training of the doctors on IPT and informing them on the importance of IPT in the management of HIV patients. Data tools were provided. A focal person was selected to fill these data tools to be able to get accurate number of HIV patients on IPT. Data was analyzed with Microsoft Excel and Epi. Info. Results: The total number of new cases of HIV seen from July to September 2013 was 218, of which (30% N=65) was started on IPT. Of the 65 that started the IPT only (63%, N=41) continued the second month. The number of suspected TB were (2.3% N=5). The number of cases of TB- Co infection (0.4% N=1). Conclusion: The IPT is being utilized in this health facility for prevention of TB in HIV/AIDs although at a low rate, however the creation of more awareness among Doctors and Patients and proper documentation, will further improve the uptake of IPT.

CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Human Immunodeficiency Virus infection is the strongest risk factor for developing tuberculosis (TB) disease in those with latent or new Mycobacterium tuberculosis infection. The risk of developing TB is between 20 and 37 times greater in people living with HIV than among those who do not have HIV infection. TB is responsible for more than a quarter of deaths in people living with HIV. Mark FC (2011), Isoniazid Preventive therapy (IPT) is the use of Isoniazid in HIV Positive individuals with latent TB infection and under five contacts of PTB index cases in order to prevent the development of active TB disease. Available evidence shows that TB is the commonest opportunistic infection and the leading cause of death among People living with HIV/AIDS (PLWHA) and also that IPT is effective in preventing it . The slogan ‘IPT works, IPT is safe, IPT works by itself or with ART` is very popular (Date AA, 2010). Research evidence exists that IPT markedly reduces the incidence of TB among people living with HIV and even among those receiving ART (WHO, 1998) .WHO and UNAID in a 1998 statement issued on the effectiveness of IPT recommended its use as part of essential care package for people living with HIV. It recommends IPT for all people living with HIV in areas with a prevalence of latent TB infection > 30% and for all people with documented latent TB infection or exposure to an infectious TB case, regardless of where they live. A reinforcing statement was released by the TB/HIV working group of the Stop TB Partnership in October 20078 (Anand AD et al, 2010). Although TB represents a potential threat to the achievable benefits of HIV scale up care and treatment, IPT represents strong potential for reduction of mortality and morbidity in people living with HIV (SPH & IST, 2009). Therefore major effort should be made to identify, prevent and treat TB among people living

with HIV in order not to lose on the progress made in care and treatment (SPH & IST, 2009). Preventive Treatment targets Infants of mothers with either Smear Negative or Positive PTB, Children under 5 years of age as TB contacts, HIV-infected individuals, Health care workers who are HIV positive and HIV positive prison inmates. IPT is not the treatment for active TB. In children living with HIV and presenting with or without positive TST, IPT was shown to reduce early mortality by 50% and incidence of TB by 70% in a small, randomized trial where ART was not widely available and it is therefore necessary to exclude active TB (Zar HJ, etal., 2007).

However, countries have been slow to adopt these recommendations and many limitations seem to be delaying effective nationwide implementation. In 2007, only 30 000 (0.1%) people living with HIV worldwide had started IPT (Comstock GW, Baum C, Snider DE,2007). The reduction of TB incidence, prevalence and death 2015 could be achieved in most of the world but the challenge will be greatest in Africa and Europe (Comstock GW, Baum C, Snider DE Jr (2007). It has been hypothesized that the reductive effect of IPT on the risk of developing TB is lifelong and has been documented in a study that the protection effect of Isoniazid prophylaxis is up to 19 years and shown to be related to the amount INH taken. In all, studies Isoniazid was generally safe and well tolerated (Woldehanna S, Volmink, 2004). In 1993, the WHO first issued a policy statement that recognized the efficacy of TB preventive therapy and recommended targeting IPT in PLHIV (WHO, 2004; WHO/IUATLD, 1993; WHO/UNAIDS, 1999). That was also the year when TB was declared a global emergency (World Health Organization, 1994). It was also packaged as one of the collaborative TB/HIV activities recommended by WHO in 2004, and repackaged as part of the Three ’I’s for HIV/TB (Isoniazid preventive treatment, infection control for TB, and intensified case finding) in 2008 (World Health Organization, 2008). It also revised its policy on IPT in 2010 reiterating the importance of IPT as a core function of services provided to PLHIV and as a primary responsibility of National AIDS Programs. The purpose of this study is to examine the use of Isoniazid prophylaxis therapy in HIV patients, the challenges and prospects. It offers simplified strategies and critical steps that are essential to scale up its implementation in high HIV prevalence countries.

1.2 OBJECTIVE OF THE STUDY

1. To determine the number of Cases of HIV placed on IPT.

2. To identify correlates of adherence and utilization of Isoniazid in HIV positive patients and to explore the opinions of patients and health care providers.

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