Predictors of isoniazid preventive therapy completion among HIV-infected patients receiving differentiated and non-differentiated HIV care in rural Uganda

AIDS Care. 2020 Jan;32(1):119-127. doi: 10.1080/09540121.2019.1619661. Epub 2019 Jun 10.

Abstract

Rates of Isoniazid Preventive Therapy (IPT) completion remain low in programmatic settings in sub-Saharan Africa. Differentiated HIV care models may improve IPT completion by addressing joint barriers to IPT and HIV treatment. However, the impact of differentiated care on IPT completion remains unknown. In a cross-sectional study of people with HIV on antiretroviral therapy in 5 communities in rural Uganda, we compared IPT completion between patients receiving HIV care via a differentiated care model versus a standard HIV care model and assessed multi-level predictors of IPT completion. A total of 103/144 (72%) patients received differentiated care and 85/161 (53%) received standard care completed IPT (p < 0.01). Adjusting for age, gender and community, patients receiving differentiated care had higher odds of completing IPT (aOR: 2.6, 95% CI: 1.5-4.5, p < 0.01). Predictors of IPT completion varied by the care model, and differentiated care modified the positive association between treatment completion and the belief in the efficacy of IPT and the negative association with side-effects. Patients receiving a multi-component differentiated care model had a higher odds of IPT completion than standard care, and the model's impact on health beliefs, social support, and perceived side effects to IPT may underlie this positive association.

Keywords: East Africa; HIV; Isoniazid preventive therapy; TB prevention; differentiated care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Antitubercular Agents / therapeutic use*
  • Cross-Sectional Studies
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Isoniazid / therapeutic use*
  • Male
  • Middle Aged
  • Rural Population*
  • Tuberculosis / complications
  • Tuberculosis / prevention & control*
  • Uganda

Substances

  • Anti-HIV Agents
  • Antitubercular Agents
  • Isoniazid