Abstract:

Globally over 10.4 million people fell ill with TB, of which 1.7 million died from the disease in 2016. And in the same year, 40% of HIV deaths were due to TB. 95% of TB deaths occur in low- and middle-income countries, and Namibia has one of the highest case notification rates (CNR) of TB in the world. Tuberculosis Presumptive Therapy (TPT) treats latent TB infection, and this reduces the likelihood that active TB disease will develop. Whereas Namibia adopted TPT use for PLHIV in 2005, the national coverage has remained low and was estimated to be 35% in June 2018, and specifically at 42% for Okahao, ART Clinic. We therefore designed a quality improvement project to scale up the uptake of TPT at this clinic. We used both quantitative and qualitative methods. We conducted health education sessions daily for 15 minutes, and patients were taught about TPT. Three categories of clients were registered according to those who suggested TPT initiation. Category one (C1) were those where a clinician suggested TPT, Category two (C2) by the client themselves and category three (C3) by data administrators. We analyzed data using simple excel spread sheets as either trend graphs or pie charts. Category two had more clients started on TPT (n=1,609, 58.3%). TPT coverage within the backlog cohort improved from 42% to 94%, and for the new cohort, coverage increased from 81% to 100%. 13 clients (64%) reported skin related manifestations as side effects. Daily health education about TPT in HIV care settings improves uptake.

References:

[1] R. Wood and L-G Bekker. (2014) Isoniazid preventive therapy for tuberculosis in South Africa: An assessment of the local evidence base. South Africa Medical Journal 104(3):174-177. DOI: 10.7196/SAMJ.7968.

[2] Danyuttapolchai J, Kittimunkong S, Nateniyom S, Painujit S, Klinbuayaem V, Maipanich N, et al. (2017) Implementing an isoniazid preventive therapy program for people living with HIV in Thailand. PLoS ONE 12(9): e0184986. https://doi.org/10.1371/journal.pone.0184986.

[3] Ayele et al. (2015) Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV: a retrospective cohort study. BMC Infectious Diseases 15:334 DOI 10.1186/s12879-015-1089-3.

[4] N. P. Spyridis, P. G. Spyridis et al. (2007) The Effectiveness of a 9-Month Regimen of Isoniazid Alone versus 3- and 4-Month Regimens of Isoniazid plus Rifampin for Treatment of Latent Tuberculosis Infection in Children: Results of an 11-Year Randomized Study. Clinical Infectious Diseases; 45:715–22

[5] S. M. Hermans, A. D. Grant, et al. (2016) The timing of tuberculosis after isoniazid preventive therapy among gold miners in South Africa: a prospective cohort study. BMC Medicine 14:45 DOI 10.1186/s12916-016-0589-3.

[6] Namibia Population6-Based HIV Impact Assessment, 2016-2017: https://phia.icap.columbia.edu/wpcontent/uploads/2018/10/NAMPHIA-pdf.

[7] Namibia7 National Guideline for Antiretroviral Therapy 2016: https://aidsfree.usaid.gov/sites/default/files/na_national_guidelines_art.Pdf.

[8] C. Padmapriyadarsini8, M. Das, et al. (2018) Is Chemoprophylaxis for Child Contacts of Drug-Resistant TB Patients Beneficial? A Systematic Review. Tuberculosis Research and Treatment, Article ID 3905890, 8 pages. https://doi.org/10.1155/2018/3905890.

[9] Thomas R. Frieden9, Harold W. Jaffe, et al. (2011) Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium Tuberculosis Infection. CDC Morbidity and Mortality Weekly Report 60:48.

[10] Lauren Hart10. (2011) Isoniazid Preventive Therapy for the Prevention of Tuberculosis in People Living with HIV/AIDS. Moving Evidence into Action.www.FHI360.org.

[11] Gavin J. Churchyard, Katherine L. Fielding, et al. (2014) A Trial of Mass Isoniazid Preventive Therapy for Tuberculosis Control. The New England Journal of Medicine 370:17, 1661-1663.

[12] J. E. Golub, S. Cohn et al. (2015) Long-term Protection from Isoniazid Preventive Therapy for Tuberculosis in HIV-Infected Patients in a Medium-Burden Tuberculosis Setting: The TB/HIV in Rio (THRio) Study. Clinical Infectious Diseases 60:4, 639-645.

[13] Basenero A, Kaliba S (2020); Using a Quality Improvement Collaborative Approach to Improve Tuberculosis prevention therapy coverage in the Kavango region, Namibia.

[14] Temprano ANRS 12136 Study Group. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N England J Med. 2015.