Adherence to Isoniazid Prevention Therapy among HIV-Positive Patients in Selected Public Hospitals in Central Embakasi Sub-County, Nairobi County, Kenya

Abstract

Globally, Tuberculosis is the most common infection that contributes to the high rates of mortality and morbidity among people living with HIV/AIDs (PLHIV). Tuberculosis remains one of the top ten causes of death globally. However, the Ministry of Health in Kenya introduced Isoniazid Preventive Therapy (IPT) as a prophylaxis for the development of active TB in people living with HIV/AIDS. IPT is given to HIV-positive patients for six months in Kenya. Approximately 1500 HIV-positive patients visit clinics to receive IPT per month in Kenya. Therefore, this study aimed to investigate IPT adherence amongst persons living with HIV/AIDS in selected health facilities in Central Embakasi sub county, Nairobi City County, Kenya. The study specifically focused on patient-provider interaction, patient-related, and socio-environmental factors associated with the level of IPT adherence. The study used a descriptive cross-sectional study design. The study employed a mixed methods approach utilizing both quantitative and qualitative research methods. The study respondents were sampled using systematic sampling with a predetermined interval of 2. A total sample of 250 people living with HIV in four selected facilities in Nairobi City County participated in the study. Quantitative data was collected using interviewer-administered research questionnaires with persons living with HIV/AIDs. Qualitative data was collected using key informant interviews with Healthcare Workers, Community Health, and Extension workers. Descriptive data was analyzed using SPSS version 22.0 with the aid of the Microsoft Excel program to generate frequency tables, graphs, and pie charts. Qualitative data was analyzed manually using a thematic analysis method. Qualitative data results were triangulated with quantitative data as direct quotes or narrations as presented by key informants. Inferential statistics were calculated using Chi-Square tests done at a 95% confidence interval and a margin of error of 0.05 to establish the association between study variables. The results showed that only 75.6% of the respondents adhered to the IPT. Among the socio-demographic factors single or divorced individuals (AOR) of 6.572 (95% CI: 2.365-18.266, p < .001), were more likely to adhere to IPT contrary to those who were married. None of the patient factors were found significant at the multivariable level. For health system factors respondents who perceived a shortage of health workers AOR of 5.953 (95% CI: 2.047-17.309, p = .001), and good time management during IPT AOR of 3.237 (95% CI: 1.153-9.084, p = .026), was associated with higher adherence. Environmental factors that were significantly associated with IPT adherence included IPT drug stockout AOR of 4.786 (95% CI: 1.778-12.883, p = .002) and community stigma AOR of 13.048 (95% CI: 3.347-50.865, p < .001). The study recommended the need for health promotion and education to provide knowledge and address issues associated with stigma.