Isoniazid Preventive Therapy (IPT) Defaulting: Who Are Responsible?

Purpose:

Infection with human immunodeficiency virus (HIV) has been identified as the strongest risk factor in the reactivation of latent or new Mycobacterium tuberculosis infection to active TB disease. TB is also the commonest cause of morbidity and mortality among the HIV-infected population in South Africa and studies have shown that TB accelerates HIV disease progression.

Isoniazid preventive therapy (IPT) is one of the interventions recommended by the WHO and the South African NDOH for the prevention of progression to active TB disease in people living with HIV (PLHIV).

The aim of the study was to describe the incidence of TB amongst HIV-positive clients who received IPT in a Primary Health Care Clinic and to identify the factors assosiated with defaulting.

 Methods:

Quantitative non-experimental descriptive retrospective cohort study was undertaken to ascertain the incidence of tuberculosis among adult HIV positive clients who received IPT. 104 clinic records of HIV positive adult clients accessing care at a Clinic in South Africa who were commenced on IPT between 01 July 2010 and 30 November 2011 were analysed.

Results:

The study findings revieled that 66 of 104 (63.5%) study respondents completed the course of IPT and the majority of those that defaulted were due to poor quality of care. Gender was statistically found to have played a role on whether a patient completes IPT. None of the study respondents that completed IPT was diagnosed with TB disease.

Conclusion:

It remains a serious concern that inadequacies or incompetence of healthcare providers were the main reasons for defaulting Isoniazid Preventive Therapy as isoniazid was not dispensed to the patients, despite the evidence of the effectiveness of the therapy as none of the patients who completed the course of IPT contracted active TB disease during the duration of the study.

Intervention strategies to improve uptake of IPT must be advocated.The findings should benefit policy makers, healthcare professionals, and particularly the patients in need.