Outcomes of Isoniazid Preventive Therapy among people living with HIV in Kenya: A retrospective study of routine health care data

Introduction Isoniazid preventive therapy (IPT) taken by People Living with HIV (PLHIV) protects against tuberculosis (TB). Despite its recommendation, there is scarcity of data on the uptake of IPT among PLHIV and factors associated with treatment outcomes. We aimed to determine the proportion of PLHIV initiated on IPT, IPT treatment outcomes and screening for TB during and after IPT.Methods A retrospective cohort study of a representative sample of PLHIV initiated on IPT between July 2015 and June 2018 in Kenya. We abstracted information on socio-demographic, TB screening practices, IPT initiation, follow up, and outcomes from health facilities’ patient record cards, IPT cards and IPT registers. Further, we assessed baseline characteristics as potential correlates of developing TB during and after treatment and IPT completion using multivariable logistic regression.Results We enrolled 138,442 PLHIV into ART during the study period and initiated 95,431 (68.9%) into IPT. Abstracted files for 4708 patients initiated on IPT, out of which 3891(82.6%) had IPT treatment outcomes documented, 4356(92.5%) had ever been screened for TB at every clinic visit and 4,243(90.1%) had documentation of TB screening on the IPT tool before IPT initiation. 3712(95.4%) of patients with documented IPT treatment outcomes completed their treatment. 42(0.89%) of the abstracted patients developed active TB, 16(38.1%) during and 26(61.9%) after completing IPT. Follow up for TB at 6-month post-IPT completion was done for 2729(73.5%) of patients with IPT treatment outcomes. Sex, Viral load suppression and clinic type were associated with TB development (p<0.05). Levels 4, 5, FBO, and private facilities and IPT prescription practices were associated with IPT completion (p<0.05).Conclusion Two-thirds of PLHIV were initiated on IPT, with a high completion rate. TB screening practices were better during IPT than after completion. Development of TB during and after IPT emphasises need for keen follow up.View Full Text