Perception of doctors of the barriers and facilitators to the implementation of isoniazid preventive therapy guidelines for HIV patients in Anambra state, Nigeria

Abstract

Background Tuberculosis (TB), an airborne infectious disease of global public health significance, is a common opportunistic infection in people living with HIV/AIDS (PLWHA). It is the leading cause of death in this group. Nigeria has a high burden of HIV/AIDS and TB as well as a high TB/HIV co-infection rate of 30/100000. To reduce TB/HIV coinfection in PLWHA who are still TB negative, Isoniazid preventive therapy (IPT) is recommended in several countries including Nigeria. Despite epidemiological evidence of its effectiveness, several key questions remain regarding the barriers and facilitators to the implementation of IPT in the Nigerian context. Aim This study aimed to explore the perceptions of doctors of barriers and facilitators of doctors to IPT in a Nigerian setting. Methodology An in-depth qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) was conducted in two health facilities in Anambra State, south-east Nigeria. Individual interviews were conducted with doctors working in the HIV clinics of both facilities. The data were analyzed using the framework approach to thematic analysis. Results Salient themes that arose from the study included participants’ awareness of IPT, participants’ perception of IPT, participants’ description of the process of IPT initiation, participants’ perception of patients’ related factors that influence IPT guideline implementation, participants’ perception of operational factors that influence IPT guideline implementation, and perception of participants on stakeholder engagement in IPT implementation. The process of initiation entailed screening of the candidates for TB and other contraindications to IPT. This is followed by the enrolment of the eligible candidates for six months course of isoniazid (INH) for the treatment of latent TB and prevention of TB disease. The study showed that unavailability of isoniazid and/or pyridoxine were barriers to IPT implementation. In addition, patients’ non-adherence to medication due to fear of drug resistance, pill burden, side effects, financial constraints, lack of sensitization among others also negatively affected doctor’s implementation of IPT. A lack of IPT specific training, poor working environment and high workload were also found to hinder the implementation of IPT guidelines. Conversely, care for patient wellbeing, the effectiveness of IPT, availability of the guideline and program sponsor involvement were found to be facilitators of the intervention in this context. Conclusion IPT is part of the routine care for patients in these facilities and although the guideline is available, there are numerous barriers to optimal implementation. Patient education and information to increase level of knowledge and more stakeholder involvement in the program will go a long way to improve the implementation of IPT for people living with HIV in Anambra state, Nigeria.