Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal: a retrospective cohort study


Objectives Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal.
Design We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres.
Setting All 11 ART centres in the FWR of Nepal.
Participants All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres.
Primary outcome measures IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated.
Result Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation.
Conclusions In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap.

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Authors & affiliation: 
Govinda Prasad Dhungana1, Pruthu Thekkur2,3, Palanivel Chinnakali4, Usha Bhatta5, Basudev Pandey6, Wei-Hong Zhang7,8 Faculty of Science and Technology, Far Western University, Mahendranagar, Nepal Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France Centre for Operational Research, The Union South-East Asia Office, New Delhi, India Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India National Center for AIDS and STD Control, Kathmandu, Nepal Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium Research Laboratory for Human Reproduction, Faculty of Medicine, School of Public Health, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
Published In: 
BMJ Open 2019;9:e029058
Publication date: 
Tuesday, April 30, 2019