Determinants of isoniazid preventive therapy completion among people living with HIV attending care and treatment clinics from 2013 to 2017 in Dar es Salaam Region, Tanzania. A cross-sectional analytical study
Determinants of isoniazid preventive therapy completion among people living with HIV attending care and treatment clinics from 2013 to 2017 in Dar es Salaam Region, Tanzania. A cross-sectional analytical study
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DOI：
10.1186/s12879-020-04997-6
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发表时间：
2020-04-10
影响因子：
3.7
通讯作者：
Maokola, Werner
中科院分区：
文献类型：
--
作者：
Robert, Masanja;Todd, Jim;Maokola, Werner
背景结核病（TB）是HIV感染者（PLHIV）中常见的机会性感染。世卫组织建议至少6个月的异烟肼预防性治疗（IPT），以降低活动性结核病的风险。重要的是要监测六个月的IPT完成，因为次优剂量可能无法保护PLHIV免受结核感染。这项研究确定了坦桑尼亚达累斯萨拉姆地区15岁或以上的艾滋病毒感染者完成6个月IPT的情况以及与完成6个月IPT相关的因素。方法对达累斯萨拉姆地区58家艾滋病病毒感染者护理和治疗诊所的常规资料进行二次分析。招募了15岁及以上的艾滋病毒感染者，他们在2013年1月至2017年6月期间对结核病症状进行了筛查，并开始了IPT。采用改良泊松回归和稳健的标准误来估计与IPT完成相关因素的患病率比（PR）和95%置信区间（CI）。多水平分析用于解释卫生机构的随机效应，以估计与IPT 6个月完成相关因素的调整PR（APR）。结果共有29，382名艾滋病毒感染者接受了IPT治疗，其中21，808名（74%）为女性。总体而言，17，092（58%）人完成了六个月的IPT，从2013年的42%（773/1857）增加到2017年的76%（2929/3856）。多水平多变量模型将卫生机构作为集群，显示未接受抗逆转录病毒治疗的艾滋病毒感染者的IPT完成率比接受抗逆转录病毒治疗的艾滋病毒感染者低46%（APR：0.54：95%CI：0.45-0.64）。从其他诊所转来的艾滋病毒感染者完成IPT的比例比未转来的人低37%（APR：0.63：95%CI（0.54-0.74））。25-34岁年龄组完成IPT的患病率比15 ~ 24岁年龄组低6%（APR：0.9495%CI：0.89-0.98）。结论HIV感染者的IPT完成率随时间的推移而增加，但从其他诊所转来的HIV感染者、年龄在25 ~ 34岁的HIV感染者和未接受抗逆转录病毒治疗的HIV感染者的IPT完成率较低，迫切需要对这些人群进行干预以支持IPT。
Background Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least 6 months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor the six-month IPT completion since a suboptimal dose may not protect PLHIV from TB infection. This study determined the six-month IPT completion and factors associated with six-month IPT completion among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods Secondary analysis of routine data from PLHIV attending 58 care and treatment clinics in Dar es Salaam region was used. PLHIV, aged 15 years and above, who screened negative for TB symptoms and initiated IPT from January, 2013 to June, 2017 were recruited. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account for health facility random effects in order to estimate adjusted PR (APR) for factors associated with IPT six-month completion. Results A total of 29,382 PLHIV were initiated IPT, with 21,808 (74%) female. Overall 17,092 (58%) six-month IPT completion, increasing from 42% (773/1857) in year 2013 to 76% (2929/3856) in 2017. Multilevel multivariable model accounting for health facilities as clusters, showed PLHIV who were not on ART had 46% lower IPT completion compared to those were on ART (APR: 0.54: 95%CI: 0.45-0.64). There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54-0.74) compared to those who did not transfer. PLHIV aged 25-34 years had a 6% lower prevalence of IPT completion as compared to those aged 15 to 24 years (APR:0.94 95%CI:0.89-0.98). Conclusion The IPT completion rate in PLHIV increased over time, but there was lower IPT completion in PLHIV who transferred from other clinics, who were aged 25 to 34 years and those not on ART. Interventions to support IPT in these groups are urgently needed.