Acceptability of isoniazid preventive therapy among Healthcare providers in selected HIV clinics in Nairobi County, Kenya
Date
2018
Authors
Wambiya, Elvis Omondi Achach
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Abstract
Background:
HIV/TB co-infection causes high morbidity and mortality among people living with HIV and places immense burden to health systems in developing settings. Isoniazid Preventive Therapy (IPT) is recognised as one of the most effective means of reducing TB burden in PLHIV yet its implementation still remains suboptimal, especially in sub-Saharan Africa. IPT implementation in Kenya (a high HIV/TB burden country) remains sub-optimal and little is known about the factors that influence its implementation. Data is also limited on the acceptability of IPT among health care providers in this context. This study assessed the factors influencing the acceptability of IPT among health care providers in selected HIV clinics in Nairobi County, Kenya.
Methods:
The study employed a cross-sectional design with an exploratory sequential mixed methods approach whereby a qualitative study was conducted followed by a quantitative survey. It was conducted in the HIV clinics of three purposively selected public health facilities. Qualitative data were collected through in-depth interviews with 18 purposively selected health care providers while quantitative data was collected from all health care providers in the clinics (74). Qualitative data on factors influencing IPT acceptability were analysed thematically and guided the development of the quantitative tool. An acceptability score was developed from nine items guided by four constructs of the Theoretical Framework for Acceptability. Explanatory variables were generated by grouping questionnaire items that assessed factors affecting acceptability. Multivariable linear regression analysis was performed to assess the relationship between the hypothesised factors and the acceptability scores.
Results
The qualitative inquiry found that policy and guideline-related, provider-related, patient-related, intervention-related, structural and operational factors influenced the acceptability of IPT among health care providers. The overall mean acceptability score in the study population was 70.33% (SD: 12.79) which was categorized as moderate. The health care providers did not find the intervention fully comfortable, agreeable or satisfactory to use. Among the determinants of acceptability of IPT, patient-related: model coefficient 5.12 (95% CI -0.39 – 10.63; P=0.050) and intervention-related: model coefficient 6.72 (95% CI 3.42– 10.01; P=0.000) factors were significantly associated with the acceptability scores in the quantitative analysis. An increase in the average composite score of these factors increased the acceptability score on average. Patient-related factors included patients’ adherence to IPT, pill burden, information on IPT, development of severe side-effects, refusal of IPT medication, clinical state and drug regimen. Intervention-related factors included INH resistance, side-effects and deaths, effectiveness of IPT, procedure of IPT related activities.
Conclusion
IPT was generally not fully acceptable among health care providers and was influenced by a number of different contextual factors. Among these, patient-related and intervention-related factors were important factors that affected the acceptability of IPT in the context of the three clinics. The promotion of evidence-based awareness and enforcement of implementation guidelines by policy makers and program managers are required to improve the acceptability of IPT among health care providers in the HIV clinics.
Description
A research report submitted to the Faculty of Health Sciences in Partial fulfillment of the requirements for the degree of
Master of Science in Epidemiology in the field of Implementation Science
School of Public Health.The University of The Witwatersrand, 25 January 2018.
Keywords
Isoniazid Preventive Therapy