Completion of isoniazid preventive therapy among HIV-infected patients in Tanzania.

SETTING

Isoniazid preventive therapy (IPT) has not been widely implemented due to questions about acceptance, adherence and side effects.

OBJECTIVE

To examine factors related to completion of IPT among human immunodeficiency virus (HIV) infected subjects in Tanzania.

DESIGN

HIV-infected subjects in the DarDar TB vaccine trial with CD4 cell counts >or=200 cells/mm(3) and a positive tuberculin skin test (TST) were counseled, offered IPT for 6 months and seen monthly.

RESULTS

Among 1932 subjects, TST results were positive in 631 (33%): 568 (90%) were offered IPT, 565 (99%) accepted and three (<1%) refused. Of the 565 subjects who accepted IPT, 493 (87%) completed treatment and 72 (13%) did not. Non-completion was physician-initiated in 24 (33%, due to active TB or side effects), patient-initiated in 42 (58%, due to self-cessation or loss to follow-up) and due to death in 6 (8%, unrelated to IPT). Interviews were conducted among 109 completers and 20 non-completers (12 physician- and 8 patient-initiated). Completers were motivated by fear of TB (44%), understanding the importance of IPT (32%) and counseling (22%). Patient-initiated non-completers were dissuaded by stigma (58%), side effects (14%) and travel distance (1%).

CONCLUSIONS

HIV-infected subjects provided with counseling, monthly follow-up and travel reimbursement have high rates of IPT completion with minimal side effects.