Abstract:
Background: This document describes a research protocol for a study designed to estimate the impact of
implementing a reminder system for medical providers on the use of isoniazid preventative therapy (IPT) for adults
living with HIV in western Kenya. People living with HIV have a 5% to 10% annual risk of developing active tuberculosis
(TB) once infected with TB bacilli, compared to a 5% lifetime risk in HIV-negative people with latent TB infection.
Moreover, people living with HIV have a 20-fold higher risk of dying from TB. A growing body of literature suggests
that IPT reduces overall TB incidence and is therefore of considerable benefit to patients and the larger community.
However, in 2009, of the estimated 33 million people living with HIV, only 1.7 million (5%) were screened for TB, and
about 85,000 (0.2%) were offered IPT.
Methods/Design: This study will examine the use of clinical decision-support reminders to improve rates of
initiation of preventative treatment in a TB/HIV co-morbid population living in a TB endemic area. This will be a
pragmatic, parallel-group, cluster-randomized superiority trial with a 1:1 allocation to treatment ratio. For the trial, 20
public medical facilities that use clinical summary sheets generated from an electronic medical records system will
participate as clusters. All HIV-positive adult patients who complete an initial encounter at a study cluster and at least
one return encounter during the study period will be included in the study cohort. The primary endpoint will be IPT
prescription at 3 months post the initial encounter. We will conduct both individual-level and cluster-level analyses.
Due to the nature of the intervention, the trial will not be blinded. This study will contribute to the growing evidence
base for the use of electronic health interventions in low-resource settings to promote high-quality clinical care,
health system optimization and positive patient outcomes.
