Process Evaluation of INN Prophylaxis Program for HIV Positive Patient in the ENARP Site

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Addis Abeba Universty


HIV infection is the greatest known risk factors for the development of active tuberculosis in individuals latently infected with tuberculosis, and there is now strong evidence for the efficacy of prophylaxis treatment in the prevention of TB in HIV infected individuals. Implementation of Isoniazid PT in developing country presents several problems; therefore this study tried to assess the IPT program implemented in the ENARP sites and its applicability in other VCT centers. The objective of this study was to evaluating operational aspect of INH prophylaxis program for Human immuno-deficiency virus positive patients in the ENARP sites. A crossectional study supplemented with review of available cohort data was conducted. All HIV positive cohort participants, in the two ENARP sites, were included Of 132 HIV positive participants 61(21.6%) were selected for INH prophylaxis program based on CD4 count who had less than 350 cell/mm3. Among 71(53.8%) participants who were not included in the IPT program, 13(18.3%) died, 37(52.1%) subjects were excluded due to their CD4 count, 13(18.3%) due to recent TB treatment history and 5(7.04%) refused to participate in the IPT program. TST were done to identify the most benefited with IPT, 44.3% were anergic and 26.2% were positive. Of 61 participant 57.4% were completed PT, 24.6% discontinued and 7(11.5%) subjects were on treatment during data collection. The study uptake looks appropriate in that the risk of having TB increases with the CD4 count less than 350 cell/mm3, OR=1.12,95% CI (1.06-1.28) .TST induration size had significant correlation with CD4 count using linear regression model and Pearson correlation analysis. Except 9.8% the rest 84.4% got health care support from the project to enhance adherence, 92.8% were agree on that ENARP staffs has good patient approach. And 86.6% were appreciate the service given to them and recommend to others. Of 61 participants 19(31.1%) missed scheduled appointment. Among 32 who completed 5(15.6%) of them missed ingesting daily pills only for a day. And INH metabolites test were positive in 80.4% of study subjects. IPT doesn't have effect on CD4 count and weight using Wilcoxon sign rank test. Ninety-three point seven of the cost of the program spent before the patient starts PT. The benefit due to PT exceeded the cost of the program by 4.99 factors. Study uptake looks appropriate, screening for active TB was performed as it was recommend by WHO. Even though different methods used to select those most benefited, it needs further evaluation. Adherence to treatment in the project favorably compares with other similar study. Therefore the project has shown the feasibility of IPT in our context.



Process Evaluation of INN Prophylaxis Program