Improving coverage and completion rate of isoniazid preventive therapy among eligible HIV patients using quality improvement approaches: a case study of State Hospital, Ijebu Ode, Ogun State, Nigeria

Pan Afr Med J. 2019 Dec 11;34:193. doi: 10.11604/pamj.2019.34.193.19360. eCollection 2019.


Introduction: Tuberculosis (TB) is a major killer of people living with HIV. One key strategy to reduce the incidence of tuberculosis in HIV patients is the use of Isoniazid Preventive Therapy (IPT). However, coverage of IPT among eligible HIV clients is poor. This study aims to improve IPT coverage using quality improvement approaches that help identify the root cause and improve coverage of isoniazid preventive therapy.

Methods: The quality improvement (QI) project spanned over six months corresponding to three PDSA cycles. Root causes for low IPT initiation and completion in State Hospital Ijebu Ode were identified using fishbone analysis. The root causes were subjected to prioritization matrix and implementation plan was developed for the first two root causes with the highest composite matrix scores. Longitudinal data were collected over the six months period with learning session at the end of every two-month PDSA cycle. Data was analyzed using Microsoft Excel 2010 and presented in charts and tables.

Results: The two most contributory factors to low IPT initiation and completion in the facility with prioritization matrix scores of 30 and 25 respectively were poor tracking system for IPT eligible clients and poor documentation of IPT commencement in the patients care cards and IPT registers. Findings showed improvement in both IPT initiation and completion with increase in initiation rate from 11% to above 50%, and increase in completion rate from 53% to 95.4%.

Conclusion: The use of quality improvement approaches can improve coverage and completion rate of IPT among eligible HIV patients. Government and health programmers should support facilities to apply QI approaches to solving health service delivery.

Keywords: HIV; isoniazid preventive therapy; quality improvement.

MeSH terms

  • Adolescent
  • Adult
  • Antitubercular Agents / administration & dosage*
  • Child
  • Delivery of Health Care / standards
  • HIV Infections / complications
  • HIV Infections / epidemiology*
  • Humans
  • Isoniazid / administration & dosage*
  • Longitudinal Studies
  • Nigeria
  • Quality Improvement
  • Tuberculosis / prevention & control*


  • Antitubercular Agents
  • Isoniazid