Abstract:
Background: Isoniazid preventive therapy (IPT) is recommended for six months to
reduce active tuberculosis burden among children living with human
immunodeficiency virus infection. This study sought to determine the level of
adherence, completion rate and factors associated with adherence to isoniazid
preventive therapy hence inform the program on the effectiveness.
Objectives: To determine the level of adherence, completion rate and describe factors
associated with adherence to isoniazid preventive therapy among children living with
human immunodeficiency virus infection at Moi Teaching and Referral Hospital.
Methods: Prospective study conducted between October 2018 to October 2019 at the
Academic Model Providing Access to Health care of Moi Teaching and Referral
Hospital among children living with human immunodeficiency virus infection aged 1-
14 years initiated on Isoniazid preventive therapy. Two hundred and fifty one children
were consecutively sampled. Data on child clinical characteristic, caregiver
characteristics, completion and adherence to isoniazid were collected using structured
questionnaire. Continuous variables summarized using median and corresponding
interquartile range. Categorical variables summarized using frequencies and
percentages. Factors associated with adherence included viral load suppression,
follow up time and caregiver level of education were assessed using logistic
regression and the odds ratios and corresponding 95% confidence interval reported.
Results: Among the 251 participants recruited the median age was 11.0 (IQR: 8.0,
13.0) years, 129(51.4%) were female, 229(92%) were virally suppressed. Caregivers
median age was 40years (IQR 35.0, 44.0), 215 (87.7%) were female, 135 (53.8%) had
primary level of education and 212 (84.5%) were aware of isoniazid preventive
therapy. Two hundred and thirty six (94%) completed 6 months of isoniazid
preventive therapy, 5 (2%) were lost to follow up and 10(4 %) were discontinued.
Good viral suppression AOR 6.23 (1.48, 26.10), and caregiver secondary level of
education AOR 0.29 (0.08, 0.96) were associated with completion. Adherence to
isoniazid preventive therapy was 80.8%. Good viral suppression AOR 25.68 (95%CI:
6.22, 105.96) and follow up time with AOR: 4.42 (95% CI: 2.01, 9.70) for month 3
and AOR 30.86 (95% CI: 8.57, 111.07) for month 6 were associated with good
adherence while participants whose caregiver had secondary/tertiary level of
education were likely to be non-adherent with AOR: 0.36 (95% CI: 0.14, 0.95).
Conclusion: Adherence and completion of isoniazid preventive therapy was good
with 8 in 10 being adherent while 9 in 10 completing. Good viral suppression and
regular follow up were associated with good adherence while participants whose
caregiver had secondary/tertiary level of education were likely to be non-adherent
and less likely to complete IPT.
Recommendation: Provision of isoniazid preventive therapy should be continued.
Further studies are needed to explore reasons why HIV infected children whose
caregivers with secondary/tertiary level of education were non-adherent.