Advanced search
1 file | 530.96 KB Add to list

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

(2019) BMJ OPEN. 9(5).
Author
Organization
Abstract
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.
Keywords
CASE NOTIFICATION RATES, ANTIRETROVIRAL THERAPY, INFECTED PATIENTS, TUBERCULOSIS INCIDENCE, PILOT PROGRAM, SCALE-UP, ADULTS, IMPLEMENTATION, PREDICTORS, ADHERENCE

Downloads

  • e029058.full.pdf
    • full text
    • |
    • open access
    • |
    • PDF
    • |
    • 530.96 KB

Citation

Please use this url to cite or link to this publication:

MLA
Dhungana, Govinda, et al. “Initiation and Completion Rates of Isoniazid Preventive Therapy among People Living with HIV in Far-Western Region of Nepal : A Retrospective Cohort Study.” BMJ OPEN, vol. 9, no. 5, 2019.
APA
Dhungana, G., Thekkur, P., Chinnakali, P., Bhatta, U., Pandey, B., & Zhang, W. H. (2019). Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study. BMJ OPEN, 9(5).
Chicago author-date
Dhungana, Govinda, Pruthu Thekkur, Palanivel Chinnakali, Usha Bhatta, Basudev Pandey, and Wei Hong Zhang. 2019. “Initiation and Completion Rates of Isoniazid Preventive Therapy among People Living with HIV in Far-Western Region of Nepal : A Retrospective Cohort Study.” BMJ OPEN 9 (5).
Chicago author-date (all authors)
Dhungana, Govinda, Pruthu Thekkur, Palanivel Chinnakali, Usha Bhatta, Basudev Pandey, and Wei Hong Zhang. 2019. “Initiation and Completion Rates of Isoniazid Preventive Therapy among People Living with HIV in Far-Western Region of Nepal : A Retrospective Cohort Study.” BMJ OPEN 9 (5).
Vancouver
1.
Dhungana G, Thekkur P, Chinnakali P, Bhatta U, Pandey B, Zhang WH. Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study. BMJ OPEN. 2019;9(5).
IEEE
[1]
G. Dhungana, P. Thekkur, P. Chinnakali, U. Bhatta, B. Pandey, and W. H. Zhang, “Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study,” BMJ OPEN, vol. 9, no. 5, 2019.
@article{8624158,
  abstract     = {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.},
  articleno    = {e029058},
  author       = {Dhungana, Govinda and Thekkur, Pruthu and Chinnakali, Palanivel and Bhatta, Usha and Pandey, Basudev and Zhang, Wei Hong},
  issn         = {2044-6055},
  journal      = {BMJ OPEN},
  keywords     = {CASE NOTIFICATION RATES,ANTIRETROVIRAL THERAPY,INFECTED PATIENTS,TUBERCULOSIS INCIDENCE,PILOT PROGRAM,SCALE-UP,ADULTS,IMPLEMENTATION,PREDICTORS,ADHERENCE},
  language     = {eng},
  number       = {5},
  pages        = {9},
  title        = {Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study},
  url          = {http://dx.doi.org/10.1136/bmjopen-2019-029058},
  volume       = {9},
  year         = {2019},
}

Altmetric
View in Altmetric
Web of Science
Times cited: