Factors Associated with Adherence to Treatment with Isoniazid for the Prevention of Tuberculosis amongst People Living with HIV/AIDS: A Systematic Review of Qualitative Data
including MEDLINE and EMBASE for articles published in peer-reviewed journals
from inception through to December 2011 for evidence relevant to IPT for TB in relation to PLWHA. Studies were assessed
for quality using the CASP critical appraisal tool for qualitative studies. Data extracted from studies were then analysed
thematically using thematic synthesis.
Factors Associated with Adherence to Treatment with Isoniazid for the Prevention of Tuberculosis amongst People Living with HIV/AIDS: A Systematic Review of Qualitative Data
Titilola Makanjuola 0
Henock B. Taddese 0
Andrew Booth 0
Olivier Neyrolles, Institut de Pharmacologie et de Biologie Structurale, France
0 1 Society for Family Health , Abuja , Nigeria , 2 School of Health and Related Research (ScHARR), University of Sheffield , Sheffield , United Kingdom
Objective: To systematically identify from qualitative data in the published literature the main barriers to adherence to isoniazid preventive therapy (IPT) for tuberculosis (TB) among people living with HIV/AIDS (PLWHA). Results: Eight studies, two of which were conducted within the same clinical trial, met the inclusion criteria. In addition to the influence of personal characteristics, five overarching themes were identified: Individual personal beliefs; HIV treatment and related issues; Socio-economic factors; Family and other social support factors, and Relationships with health providers. The review confirms current understanding of adherence to treatment as influenced by patients' understanding of, and beliefs related to treatment regimens. This is in-turn influenced by broader factors, namely: socio-economic factors such as poverty and lack of health facilities; the level of support available to patients from family and other networks and the stigma that emanates from these relationships; and relationships with health providers, which in-turn become a delicate issue given the sensitivity of dealing with two chronic diseases of significant morbidity and mortality toll. HIV treatment related issues also influence adherence to IPT, whereby challenges related to the acceptance, organisation and administration of these two long-term treatment regimens and stigma related to HIV/AIDS, are seen to be major factors. Conclusion: Understanding this complex interplay of factors more clearly is essential for healthcare decision-makers to be able to achieve the level of adherence required to effectively mitigate the threat posed by co-infection with TB and HIV/ AIDS in developing countries.
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Tuberculosis (TB) is the most common opportunistic infection
and leading cause of mortality in people living with HIV/AIDS
(PLWHA). In PLWHA, the risk of developing TB is 2134 times
greater than those without HIV infection [1]. Globally, around 1.1
million people were estimated to be co-infected with HIV and TB
in 2010, representing in excess of 10% of the 9 million new cases of
TB that year [1]. This overall trend differs according to the state of
the HIV epidemic in different settings. In hard hit areas such as
Sub-Saharan Africa (where there is a generalized HIV epidemic),
PLWHA represent around 39% of new TB cases [1]. Co-infection
with HIV and TB resulted in some 0.35 million TB attributable
deaths amongst people living with HIV worldwide, in the year
2010 [1].
The interaction between HIV and TB is bidirectional with each
disease potentiating the adverse effects of the other. This, in turn,
affects the prognosis of patients and complicates clinical diagnosis
and treatment plans through atypical presentation of symptoms,
adverse drug reactions, overlapping drug toxicities and drug-drug
interactions between Highly Active Anti-Retroviral Therapy
(HAART) and anti-TB drugs [2,3,4]. Co-infection with HIV
and TB adds significantly to the burden on health systems in the
developing world and complicates and threatens efforts aimed at
achieving globally set development and health objectives [2,3,4,5].
Isoniazid preventive therapy (IPT) for people living with HIV,
who do not have active TB, is one of the strategies recommended
by the World Health Organization (WHO) and the Joint United
Nations Programme on HIV/AIDS (UNAIDS) to enable the
effective prevention, diagnosis and treatment of TB in PLWHA
[6,7,8]. The recommended regimen for TB preventive therapy in
adolescents and adults is isoniazid (isonocotic acid hydrazide
INH), 300 mg daily for at least 6 months [8,9]. A Cochrane review
assessing the effectiveness of TB preventive therapy in reducing
the risk of active TB and death in persons infected with HIV,
confirms that chemoprophylaxis with anti-tuberculosis drugs
reduces the risk of clinical tuberculosis in HIV infected
populations [10]. The review also cautions about the dangers of poor
adherence and drug resistant TB disease potentially associated
with the use of long courses of isoniazid monotherapy [10].
Various health system related constraints have impeded the
uptake of IPT. Only 12% of PLWHA who were n (...truncated)