Adherence to isonazid preventive therapy among Human Immunodeficiency Virus infected children At comprehensive care clinic in Moi Teaching and Referral Hospital, Eldoret

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.