Adherence to tuberculosis preventive therapy among HIV-infected persons in Chiang Rai, Thailand.
OBJECTIVE
To determine the level of and reasons associated with adherence to tuberculosis preventive therapy among asymptomatic HIV-infected individuals in northern Thailand.


METHODS
A prospective cohort study with a 9-month follow-up.


METHODS
A total of 412 HIV-infected persons were enrolled in a tuberculosis preventive therapy programme in a hospital. A 9-month isoniazid regimen was prescribed. Adherence was determined by pill count. Participants who missed a scheduled appointment for more than a month were interviewed. Five focus group discussion sessions were held among those who successfully completed the therapy.


RESULTS
Of the 412 participants, 69.4% (286) completed the 9-month regimen. The adherence rate, defined as the proportion of those who took more than 80% of pills, was 67.5% (n = 278). Sex, source of participants and history of physical symptoms were associated with adherence. A significant portion of defaults took place at the beginning of the therapy. Out-migration, denial of HIV status, and perceived side effects of isoniazid were frequently cited as reasons for non-adherence. For those adhering participants, the acceptance of personal HIV status, concern about children and family, and a good health provider relationship were important reasons motivating adherence. Several reminder systems were developed by the participants.


CONCLUSIONS
Although a isoniazid preventive therapy programme was shown to be feasible, further adjustments on the selection of participants, enrollment process, and follow-up system based on these findings are necessary to increase the adherence.
Ngamvithayapong
J
J
College of Public Health, Chulalongkorn University, Bangkok, Thailand.
Uthaivoravit
W
W
Yanai
H
H
Akarasewi
P
P
Sawanpanyalert
P
P
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D013785:Thailand; D014376:Tuberculosis / Q000517:prevention & control*
D000995:Antitubercular Agents; D007538:Isoniazid