Background: South Africa is experiencing the worst HIV-driven tuberculosis (TB)
epidemic in the world. More than 300,000 new cases of active TB are reported in
the country each year with 60% co-infected with HIV. Isoniazid preventive
therapy (IPT) is a key public health intervention for the prevention of TB
among people living with HIV (PLHIV) and is recommended as part of a
comprehensive HIV and AIDS care strategy. However, program data suggests that
coverage of IPT service to be very low. This study aims to assess IPT initiation rate among newly
diagnosed HIV-positive persons in three high HIV-burden districts of South
Africa. Methods: A cross-sectional study was conducted using routine
data generated from pre-ART and ART programs in 35 purposively selected primary
health care (PHC) clinics in South Africa. The facilities were selected from
three high HIV-burden districts with a mix of urban and rural settings. TB
screening and IPT initiation status was assessed within a window period of
one-year post HIV diagnosis. Initiation rate of IPT services among newly
diagnosed HIV-positive persons was assessed. The chi-squared test was used to
determine whether there was a significant difference in the proportion of newly
diagnosed HIV-positive persons who were initiated on IPT by sex, age group,
pregnancy status, health facility, district and location of facility. Results: We identified 12,413 newly diagnosed HIV patients aged 12-years-old and above
between June 1, 2014 and March 31, 2015. TB screening was not conducted among 33%
of newly diagnosed HIV-positive persons to rule out or confirm the presence of
active TB. IPT was initiated in 42.2% of known IPT-eligible HIV-positive
persons. Initiation of IPT services was lower in younger patients aged 12 to
20-years-old compared to older patients. The proportion of pregnant women who
were initiated on IPT was higher compared to the proportion in non-pregnant
women (51.0% and 40.1% respectively; P < 0.05). Health care clinics located
in uThukela health district registered the highest initiation rates of IPT care
(48.1%; CI: 46.2%, 50.1%) compared to clinics located in Gert Sibande (40.4%;
CI: 38.7%, 42.2%) health district and Johannesburg Health District (38.5%; CI:
36.4%, 40.7%). Conclusion: This analysis shows that initiation rate of
IPT services among newly diagnosed HIV positive persons was low in the 35
participating facilities during the period under investigation. There was
variability in IPT initiation rates across the facilities included in this
study and among different
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