Predictors of isoniazid preventive therapy completion among HIV-infected patients receiving differentiated and non-differentiated HIV care in rural Uganda

ABSTRACT

Rates of Isoniazid Preventive Therapy (IPT) completion remain low in programmatic settings in sub-Saharan Africa. Differentiated HIV care models may improve IPT completion by addressing joint barriers to IPT and HIV treatment. However, the impact of differentiated care on IPT completion remains unknown. In a cross-sectional study of people with HIV on antiretroviral therapy in 5 communities in rural Uganda, we compared IPT completion between patients receiving HIV care via a differentiated care model versus a standard HIV care model and assessed multi-level predictors of IPT completion. A total of 103/144 (72%) patients received differentiated care and 85/161 (53%) received standard care completed IPT (p < 0.01). Adjusting for age, gender and community, patients receiving differentiated care had higher odds of completing IPT (aOR: 2.6, 95% CI: 1.5–4.5, p < 0.01). Predictors of IPT completion varied by the care model, and differentiated care modified the positive association between treatment completion and the belief in the efficacy of IPT and the negative association with side-effects. Patients receiving a multi-component differentiated care model had a higher odds of IPT completion than standard care, and the model’s impact on health beliefs, social support, and perceived side effects to IPT may underlie this positive association.

KEYWORDS:

• Isoniazid preventive therapy
• TB prevention
• East Africa
• HIV
• differentiated care

Acknowledgements

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, PEPFAR, or Gilead. The SEARCH project gratefully acknowledges the Ministries of Health of Uganda and Kenya, our research team, collaborators and advisory boards, and especially all communities and participants involved.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research reported in this manuscript was supported by the Division of AIDS, NIAID of the National Institutes of Health under award number U01AI099959 and in part by the U.S. President’s Emergency Plan for AIDS Relief, Bill and Melinda Gates Foundation, and tenofovir study drug was donated to the SEARCH study by Gilead Sciences. CM is partially supported by a grant from NIH/NIAD K23AI118592. KHT was partially supported by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at UCSF.