Low completion rate for the 6-months course of isoniazid preventive therapy among people living with HIV, North Eastern Uganda, 2015-2017

Abstract

Introduction: isoniazid preventive therapy (IPT) is highly effective at preventing tuberculosis among Persons Living with HIV (PLHIV). However, IPT completion rates in Uganda have not been studied. We examined completion rates for the 6-month course of IPT and factors associated with non-completion among PLHIV in north-eastern Uganda.

Methods: we conducted a retrospective cohort study using routinely collected program data in nine Antiretroviral Therapy (ART) sites in north-eastern Uganda. The study period covered January 2015-December 2017. Non-completion was defined as failure to pick up any of the six IPT refills over 6 months. We abstracted data on IPT treatment site, IPT completion, and demographic and clinical characteristics from the IPT register and patient HIV care card. We used generalized linear regression to identify factors associated with non-completion.

Results: among 543 patients who started IPT, 175 (32%) completed the full 6-month course. Among those who did not complete, 193 (52%) stopped due to drug stockouts, and 175 (48%) were lost to follow-up. Being at World Health Organization (WHO) HIV clinical stages III and IV at initiation were associated with a higher risk of IPT non-completion compared to those who were at WHO clinical staging I and II (aRR 1.4, 95%CI 1.2-1.5).

Conclusion: IPT completion rate among PLHIV in north-eastern Uganda was suboptimal, largely due to IPT drug stockouts. The National TB and Leprosy Program should streamline the IPT supply chain to address drug stockouts and improve completion rates.