Suboptimal Use of Isoniazid Preventive Therapy among People Living with HIV in Nyanga District, Zimbabwe, 2021

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  • Sexually Transmitted Diseases
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Zimbabwe is listed among the top 30 countries with a high burden of tuberculosis (TB) and HIV co-infection. Isoniazid Preventive Therapy (IPT) is recommended for treatment of latent TB infection among people living with HIV (PLHIV). Nyanga District enrolled 154(11.3%) out of 1358 eligible clients on IPT against a target of 95%, in 2020. We evaluated the IPT program in Nyanga District for the period 2019-2020, assessed the reasons for low enrollment and determined the preferred differentiated service delivery (DSD) models for IPT among PLHIV.

We conducted a process-outcome evaluation using a logic model approach. We used cluster random sampling to enroll 90 PLHIV and enrolled 53 health workers at 22 health facilities in Nyanga District. Data were collected using interviewer-administered questionnaires, record reviews, and checklists. We generated medians, frequencies, and proportions using Epi Info version 7.

Among PLHIV, 25/90(28%) had a previous TB diagnosis while 43/90(47%) had received IPT. The reasons for low enrolment on IPT as stated by health workers were patients’ refusal due to fear of drug reactions 33/53(62%), high pill burden 30/53(57%), isoniazid stock out 30/53(57%) and pyridoxine stock out 27/53(51%). There was no information, education, and communication (IEC) material on IPT at all health facilities. Out of 7896 clients in care, 5414/7896(69%) were screened and eligible for IPT, 1512/5414(28%) were started on IPT and 1010/1512(66%) completed therapy. Facility based six-month drug dispensing was the preferred IPT delivery model.

There is suboptimal performance of the IPT program in Nyanga characterized by low enrollment on IPT attributable to fear of side effects, high pill burden and intermittent supply of medicines. We recommended expedited transition to short course TB preventive therapy regimes, availing IEC material and setting quarterly, site-specific IPT initiation targets. We developed an expiry tracker for monitoring isoniazid and pyridoxine stocks at facility and district level.

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