Study Setting and design
An Institution based cross-sectional study was conducted on 1st May 2016—30 June 2016 in JUSH HIV care, Oromia region, Ethiopia. JUSH is located in Jimma town, which provides health service for 15 million people residing in South West of the country. It has one ART clinic launched in the year 1998 GC. The total number of PLHIV enrolled in this clinic since its establishment was 7690, and one thousand patients have stopped ART regimen. There were 6690 HIV-infected patients who are under follow up in the ART clinic on May 2016.
IPT program in Ethiopia
IPT implementation was initiated in 2008 in Ethiopia. Our government recognized the burden of TB/HIV confection and implemented the therapeutic guidelines in national TB—strategic plan 2011—2015. According to its policy, all PLHIV should be screened for TB using WHO four symptoms (current cough, fever, night sweats or weight loss) based screening. The eligible screened patients without active TB will be prescribed with IPT for 6 months. The National target for IPT initiation for eligible PLHIV is 100%.
Patients enrolled in HIV care at the age of 15—68 years who were eligible for IPT, HCP’S working in ART clinic and TB/HIV coordinators in JUSH are considered in the study.
Inclusion criteria for Participants
- Adult PLHIV enrolled in the HIV care at JUSH. We included the adult PLHIV who were eligible for IPT from the medical records, including patients who were taking IPT.
- Adult PLHIV who were on follow-up and eligible for IPT during our study period, permanent HCPs and TB/HIV coordinators working in JUSH HIV care, who showed voluntary participation for semi-structured questioners and an in-depth interviews were included as a participants in the qualitative study.
Patients whose symptoms are positive in TB screening, identification of active TB, acute/chronic hepatitis, alcoholics, peripheral neuropathy, prior allergy or intolerance to isoniazid were excluded from the analysis.
The sample size was calculated by single population proportion formula n = Zα / 2 p (1—p) /d2 using (p = 22%; 95% CI and 5% precision) the prevalence of IPT use in HIV-infected patients in ART clinic, Black lion hospital, Addis Ababa [16, 19]. We considered that 10% of the patient as expected loss and the final sample size were 287. The respondents were selected by systematic sampling technique. More explicitly, study subjects were at the 24th interval in the sampling frame and the initial respondent being the first patient in HIV care. We excluded 9 patients who had active TB disease, and 2 had a history of chronic alcoholism for which we recruited an additional 11 patients to reach our sample size. We considered that IPT utilization as continuous a dependent variable and sex, age, marital status, education, ethnicity, religion, occupation, residence, BMI, WHO Clinical stages, duration of HIV care, types of HIV care, duration of HAART care, CD4 count, co-morbidity, previous TB treatment, patients taking medication, baseline availability of LFT, RFT, Hgb, HBsAg and Anti HCV as an independent variables.
To achieve the objectives of the study, we used a convenient sampling technique for semi-structured questioners and an in-depth interview from the patients who were included in the study (from both those who took IPT and those who did not take IPT). In addition, we made a visit to the ART clinic during the study time, and interviewed the health care workers at TB/HIV clinics and TB/HIV coordinators working in JUSH, ART clinic. The questionnaires were developed according to standard WHO 6 health system frames , and in-depth interviews were imployed till data saturation occurred. The core ideas originated as barriers and factors that increase the IPT implementation were grouped into three categories as patient-related factors, HCP’s and TB/HIV coordinator perspectives. All questionnaires were pre-coded and target group interviews were audio recorded and cross-checked for completeness prior to computation.
Definition of variables
IPT users/utilizers: PLHIV who were initiated on INH (isoniazid) 300mg daily as IPT and who were either taking during data collection or PLHIV who were prescribed IPT for one month and whose status after initiation is known or unknown.
Previous TB treatment: patients who took the standard anti-TB drugs for ≥ 1months and not taking the drugs during the study time despite the treatment outcomes
Adult PLHIV: defined as PLHIV whose age ≥15 years as this cut of age is used for classification of adult and pediatric clinics in JUSH and other governmental hospitals in Ethiopia.
Ethical clearance was acquired from Institutional Review Board (IRB) of the College of Health science and Ethical review committee of JUSH (Ref. No: RPGC/14/2016). As per HIV programme protocols, the resident Physicians are permitted to collect the data for evaluating the strength and weakness of the program and to act accordingly. Written consent was obtained from each subject and passive parental consent from the parent (or) guardian was received for the patients < 18 years. All interview script was coded, and none of the patient identifiers as included in data assessment.
All quantitative data were coded through Epi Data 3.1 and then exported to SPSS version 20 for indepth analysis. Descriptive statistics, χ2 test and bivariate analysis were done to sort variables for logistic regressions having value P ≤ 0.25. A stepwise logistic regression model was used to generate factors strongly associated with the dependent variable. A value of P < 0.05 was considered as significant to declare the associations. Qualitative data were subjected to thematic analysis which involves identifying, coding, analyzing and clustering recurring factors into overarching themes with respective sub-themes. Additionally, data’s collected from the patients, HCP’s and TB/HIV coordinators for the IPT utilization were described based on their categories to add depth and richness to the findings.