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Completion of isoniazid preventive therapy among human immunodeficiency virus positive adults in urban Malawi

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Thindwa, D, MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613, Choko, A. T., Khundi, M., Sambakunsi, R., Ngwira, L. G., Kalua, T., Webb, E. L. and Corbett, E (2018) 'Completion of isoniazid preventive therapy among human immunodeficiency virus positive adults in urban Malawi'. The International Journal of Tuberculosis and Lung Disease, Vol 22, Issue 3, pp. 273-279.

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Abstract

SETTING:
Despite worldwide scale-up of human immunodeficiency virus (HIV) care services, relatively few countries have implemented isoniazid preventive therapy (IPT). Among other programmatic concerns, IPT completion tends to be low, especially when not fully integrated into HIV care clinics.
OBJECTIVE:
To estimate non-completion of 6-month IPT and its predictors among HIV-positive adults aged 16 years.
DESIGN:
A prospective cohort study nested within a cluster-randomised trial of TB prevention was conducted between February 2012 and June 2014. IPT for 6 months was provided with pyridoxine at study clinics. Non-completion was defined as loss to follow-up (LTFU), death, active/presumptive TB or stopping IPT for any other reason. Random-effects logistic regression was used to determine predictors of non-completion.
RESULTS:
Of 1284 HIV-positive adults initiated on IPT, 885/1280 (69.1%) were female; the median CD4 count was 337 cells/μl (IQR 199-511); 320 (24.9%) did not complete IPT. After controlling for antiretroviral treatment status, IPT initiation year, age and sex, non-completion of IPT was associated with World Health Organization stage 3/4 (aOR 1.76, 95%CI 1.22-2.55), CD4 count 100-349 cells/μl (aOR 1.93, 95%CI 1.10-3.38) and any reported side effects (aOR 22.00, 95%CI 9.45-46.71).
CONCLUSION:
Completion of IPT was suboptimal. Interventions to further improve retention should target immunosuppressed HIV-positive adults and address side effects.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268 Antitubercular agents. Antitubercular antibiotics
QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268.5 Antiviral agents (General)
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.5588/ijtld.17.0370
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 28 Feb 2018 16:46
Last Modified: 28 Feb 2018 16:46
URI: http://archive.lstmed.ac.uk/id/eprint/8298

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