Tuberculosis coinfected with HIV constitutes a large proportion of patients in Ethiopia. Isoniazid preventive therapy (IPT) is recommended for the treatment of latent tuberculosis infection. However, the level of IPT adherence and associated factors among people living with HIV (PLHIV) have not been well explored. This study aimed to assess adherence to IPT and associated factors among PLHIV in Addis Ababa. Facility based cross-sectional study was conducted. The study was conducted in 10 health centers and 2 hospitals. Patients were consecutively recruited till the required sample size was obtained. From 406 PLHIV approached, a total of 381 patients on IPT were interviewed. Data were entered and analyzed using Epi-Info version 3.5 and SPSS version 16. The level of adherence to IPT was 89.5%. Patients who have taken isoniazid for ≥5 months were more likely to be adherent than those who took it for 1-2 months [AOR (95%CI) = 5.09 (1.41–18.36)]. Patients whose friends decide for them to start IPT were less likely to be adherent than others [AOR (95%CI) = 0.10 (0.01–0.82)]. The level of adherence to IPT in PLHIV was high. Counseling of patients who are in their first two months of therapy should be more strengthened. Strong Information Education Communication is essential to further enhance adherence. 1. Introduction Globally, the number of people living with HIV (PLHIV) continues to grow. According to UNAIDS report, globally, an estimated 35.3 (32.2–38.8) million people were living with HIV and 1.6 (1.4–1.9) million AIDS related deaths in 2012. Sub-Saharan Africa continues to bear the burden of the global epidemic. A total of 25.0 (23.5–26.6) million people were living with HIV in 2012 in sub-Saharan Africa and an adult prevalence of 4.7% is reported [1–3]. With an estimated 1.1 million PLHIV, Ethiopia has one of the largest populations of HIV infected people in the world. However, HIV prevalence among the adult population is lower than many sub-Saharan African countries. The national and Addis Ababa adult HIV prevalence in 2010 was estimated to be 2.4% and 9.2%, respectively [4, 5]. TB though curable, it is one of the most common causes of HIV-related illness and death. About 11.5 million adults living with HIV/AIDS are estimated to be coinfected with Mycobacterium tuberculosis, with 71% of those coinfected living in sub-Saharan Africa. In Ethiopia, routine data from 44 sites in the year 2005/2006 showed that 41% of TB patients are HIV positive. Another routine data collected in 2006/2007 showed that coinfection is 31% [2, 6]. HIV is the most important
References
[1]
WHO and USAID, Core Epidemiology Slides, Global Summary of the AIDS Epidemic 2012, 2013.
[2]
WHO, Guide Lines for Implementing Collaborative TB and HIV Programme Activities, World Health Organization, Geneva, Switzerland, 2003.
[3]
UNAIDS, “Global report on the global AIDS epidemic,” 2013.
[4]
Federal Democratic Republic of Ethiopia and Federal HIV/AIDS Prevention and Control Office, “Report on Progress Towards Implementation of The UN Declaration of Commitment on HIV/AIDS,” Addis Ababa, Ethiopia, 2010.
[5]
Federal Minstry of Health & Federal HIV/AIDS Prevention and Control Office, Single Point HIV Prevalence Estimate, Addis Ababa, Ethiopia, 2007.
[6]
Federal Ministry of Health, Tuberculosis, Leprosy and TB/HIV Prevention and Control Programme Manual, Federal Ministry of Health, Addis Ababa, Ethiopia, 4th edition, 2008.
[7]
Federal Minstry of Health, TB/HIV and Leprosy Prevention and Control Strategic Plan, Federal Minstry of Health, Addis Ababa, Ethiopia, 2007–2009.
[8]
WHO, TB/HIV Clinical Manual, 2004.
[9]
WHO, Three I's Meeting, World Health Organization, Geneva, Switzerland, 2008.
[10]
L. Martin, S. Williams, and R. Dimatto, “The challenge of patient adherence,” The Clinical Risk Management, vol. 1, no. 3, pp. 189–199, 2005.
[11]
E. Vermeire, H. Hearnshaw, P. van Royen, and J. Denekens, “Patient adherence to treatment: three decades of research: a comprehensive review,” Journal of Clinical Pharmacy and Therapeutics, vol. 26, no. 5, pp. 331–342, 2001.
[12]
International AIDS Society—USA, “Tuberculosis and HIV in the Caribbean: approaches to diagnosis, treatment, and prophylaxis,” Topics in HIV Medicine, vol. 12, no. 5, pp. 144–149, 2004.
[13]
WHO, Interim Policy on Collaborative TB/HIV Activities, Geneva, Switzerland, 2004.
[14]
M. G. Amuha, P. Kutyabami, F. E. Kitutu, R. Odoi-Adome, and J. N. Kalyango, “Non-adherence to anti-TB drugs among TB/HIV co-infected patients in Mbarara Hospital Uganda: prevalence and associated factors,” African Health Sciences, vol. 9, supplement 1, pp. S8–S15, 2009.
[15]
M. Mindachew, A. Deribew, F. Tessema, and S. Biadgilign, “Predictors of adherence to isoniazid preventive therapy among hiv positive adults in Addis Ababa, Ethiopia,” BMC Public Health, vol. 11, article 916, 2011.
[16]
Addis Ababa City Adminstration Health Bureau, Operational Manual for Regional HIV/AIDS Care and Treatment Catchments Team Activities, Addis Ababa City Adminstration Health Bureau, Addis Ababa, Ethiopia, 2010.
[17]
D. A. Mitchison, “How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis,” International Journal of Tuberculosis and Lung Disease, vol. 2, no. 1, pp. 10–15, 1998.
[18]
T. A. Szakacs, D. Wilson, D. W. Cameron et al., “Adherence with isoniazid for prevention of tuberculosis among HIV-infected adults in South Africa,” BMC Infectious Diseases, vol. 6, article 97, 2006.
[19]
D. Taddesse, Assesement of IPT Implementation, Adherence and its Determinats in the Public Health Facilities of Diredawa UOG/ACIPH, 2009.
[20]
B. S. Sutton, M. S. Arias, P. Chheng, M. T. Eang, and M. E. Kimerling, “The cost of intensified case finding and isoniazid preventive therapy for HIV-infected patients in Battambang, Cambodia,” International Journal of Tuberculosis and Lung Disease, vol. 13, no. 6, pp. 713–718, 2009.
[21]
T. Aisu, M. C. Raviglione, E. van Praag et al., “Preventive chemotherapy for HIV-associated tuberculosis in Uganda: an operational assessment at a voluntary counselling and testing centre,” AIDS, vol. 9, no. 3, pp. 267–273, 1995.
[22]
M. L. Garcia, J. L. Valdespino, C. Garcia-Sancho, et al., “Compliance and side effects to chemoprophylaxis for TB in HIV+ Mexican experience,” in Proceedings of the International Conference on AIDS, 9 (324), abstract no. PO-B07-1133, 1993.
[23]
J. Ngamvithayapong, W. Uthaivoravit, H. Yanai, P. Akarasewi, and P. Sawanpanyalert, “Adherence to tuberculosis preventive therapy among HIV-infected persons in Chiang Rai, Thailand,” AIDS, vol. 11, no. 1, pp. 107–112, 1997.
[24]
M. Bakari, A. Moshi, E. A. Aris et al., “Isoniazid prophylaxis for tuberculosis prevention among HIV infected police officers in Daresalaam,” East African Medical Journal, vol. 77, no. 9, pp. 494–496, 2000.
[25]
R. L. Ailinger, J. B. Moore, N. Nguyen, and H. Lasus, “Adherence to latent tuberculosis infection therapy among latino immigrants,” Public Health Nursing, vol. 23, no. 4, pp. 307–313, 2006.
[26]
P. J. Munseri, E. A. Talbot, L. Mtei, and C. F. Von Reyn, “Completion of isoniazid preventive therapy among HIV-infected patients in Tanzania,” International Journal of Tuberculosis and Lung Disease, vol. 12, no. 9, pp. 1037–1041, 2008.