Factors Associated with Compliance to Isoniazid Preventive Therapy among HIV Patients Attending Comprehensive Care Clinic at Chuka County Referral Hospital, Kenya

Abstract

Tuberculosis is the most frequent life-threatening opportunistic disease among people living with HIV/AIDs (PLHIV) and it remains a leading cause of mortality, even among patients receiving antiretroviral therapy (ART). Isoniazid preventive therapy (IPT) reduces the risk of active TB by approximately 85% and is therefore an effective intervention in preventing progression of latent TB to active TB among PLHIV. Despite its proven effectiveness, the implementation has been very low and slow, hindered by various socio demographic, clinical-related and health facility factors. This research sought to assess the factors influencing compliance and the successful implementation of the isoniazid preventive therapy among HIV patients attending comprehensive care clinic at Chuka County Referral Hospital, Tharaka Nithi County. The study Specifically focused on assessing the socio demographic, clinical related and health system factors that are associated with compliance to isoniazid preventive therapy. A descriptive cross sectional study design adopted with the target population being HIV positive patients attending Comprehensive Care Clinic (CCC) services at Chuka county referral hospital. Systematic random sampling method used as the sampling technique with a predetermined interval of four was applied to select participants. Data collection was carried out using interviewer-administered questionnaires and focus group discussions. Quantitative information was analysed using SPSS version 25. Inferential statistics were calculated using Chi-Square tests at a 95% confidence interval and a margin of error of 0.05 to establish the association between study variables. The results revealed that only 57% of the respondents compliedwith IPT. The Chi square method was used to test the association between compliance and the various demographic, clinical, and health system factors under study. On socio-demographic factors the results showed that there was a significant association between sex and compliance with isoniazid preventive therapy (IPT). Females respondents were 2.51 times more likely to be compliant with IPT compared to males [95%CI = 1.55– 4.07, p < 0.001]. Respondents with tertiary education were 2.56 times more likely to be compliant with isoniazid preventive therapy compared to those with secondary or primary education [AOR =2.56, 95% CI: 1.41 – 4.78, p=0.002]. Among patient-related factors the study results found out that respondents who knew the reason for taking the drug were 6.43 times more likely to comply with isoniazid preventive therapy compared to those who did not know the reason for taking the drug [AOR= 6.43, 95% CI: 2.65 – 8.32, p=0.004]. Similarly respondents who did not experience side effects while taking the drugs were 3.67 times more likely to be compliant compared to those who reported experiencing side effects [AOR=3.67, 95% CI: 2.54 – 7.45, p<0.001]. Health system related factors results showed that respondents whose distance from their home to the health facility was approximately 0 – 10km were 7.43 times more likely to be compliant to isoniazid preventive therapy compared to those whose distance was approximately 21 – 30km [AOR= 7.43 95% CI: 3.89– 9.45, p=0.028]. In addition respondents who reported receiving isoniazid medicine during their appointment were 4.32 times more likely to be compliant [AOR= 4.32 95% CI: 2.12 – 6.98, p=0.001] compared to those who did not receive the medicine. The study recommended the need for health promotion and education to provide knowledge on the reason for taing the drug and also to address issues of side effects.