Provider Barriers to the Uptake of Isoniazid Preventive Therapy among People Living with HIV in Ethiopia
Provider Barriers to the Uptake of Isoniazid Preventive Therapy among People Living with HIV in Ethiopia
Abstract
Setting
Sixty-seven government health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services across Ethiopia.
Objective
To examine clinician barriers to implementing isoniazid preventive therapy (IPT) among people living with HIV.
Design
A cross-sectional study to evaluate the provider-related factors associated with high IPT coverage at the facility level.
Results
On bivariate analysis, the odds of high IPT implementation were lower when clinicians felt patients were negatively affected by the side effects of IPT (OR 0.18, 95%CI 0.04–0.81) and perceived that IPT increased multidrug-resistant TB (MDR-TB) rates (OR 0.66, 95%CI 0.44–0.98). The presence of IPT guidelines on site (OR 2.93, 95%CI 1.10–7.77) and TB-HIV training (OR 3.08, 95%CI 1.11–8.53) had a positive relationship with high IPT uptake. In the multivariate model, clinicians’ perception that active TB was difficult to rule out had a negative association with a high IPT rate (OR 0.93; 95%CI 0.90–0.95).
Conclusions
Clinician impression that ruling out active TB among HIV patients is difficult was found to be a significant barrier to IPT uptake. Continued advancement of IPT relies greatly on improving the ability of providers to determine IPT eligibility and more confidently care for patients on IPT. Improved clinician support and training as well as development of new TB diagnostic technologies could impact IPT utilization among providers.
Related Content
Digitization as a Key Tool for Ensuring Data Quality and Improvement of the TB Program in Ethiopia
Uganda SSCS Impact Story—July 2024: Improved Tracking, Tracing, and Visibility of Commodities in Hard-to-Reach Health Facilities Using an Integrated Solar-Powered System
