title: A recent HIV diagnosis is associated with non-completion of Isoniazid Preventive Therapy in an HIV-infected cohort in Cape Town.
abstract: BACKGROUND
  Despite high rates of successful treatment TB incidence in South Africa remains high, suggesting ongoing transmission and a large reservoir of latently infected persons. Isoniazid preventive therapy (IPT) is recommended as preventive therapy in HIV-infected persons. However, implementation has been slow, impeded by barriers and challenges including the fear of non-adherence.
  
  
  OBJECTIVE
  The aim was to evaluate predictors of IPT non-completion. One hundred and sixty four antiretroviral therapy (ART)-naïve HIV-infected patients with tuberculin skin test ≥5 mm were recruited from Khayelitsha day hospital and followed up monthly. A questionnaire was used to collect demographic information.
  
  
  RESULTS
  The overall completion rate was 69%. In multivariable analysis, there was a 29% decrease in risk of non-completion for every year after HIV diagnosis (OR 0.81; 95% C.I. 0.68-0.98). Self-reported alcohol drinkers (OR 4.05; 95% C.I. 1.89-9.06) also had a four-fold higher risk of non-completion, with a strong association between alcohol drinkers and smoking (χ(2) 27.08; p<0.001).
  
  
  CONCLUSIONS
  We identify patients with a recent HIV diagnosis, in addition to self-reported drinkers and smokers as being at higher risk of non-completion of IPT. The period of time since HIV diagnosis should therefore be taken into account when initiating IPT. Our results also suggest that smokers and alcohol drinkers should be identified and targeted for adherence interventions when implementing IPT on a wider scale.
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. tolullahoni@doctors.org.uk
authors.forename: Tolu
authors.initials: T
authors.lastname: Oni
authors.forename: Relebohile
authors.initials: R
authors.lastname: Tsekela
authors.forename: Bekekile
authors.initials: B
authors.lastname: Kwaza
authors.forename: Lulama
authors.initials: L
authors.lastname: Manjezi
authors.forename: Nonzwakazi
authors.initials: N
authors.lastname: Bangani
authors.forename: Katalin A
authors.initials: KA
authors.lastname: Wilkinson
authors.forename: David
authors.initials: D
authors.lastname: Coetzee
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D010349:Patient Compliance; D013019:South Africa; D013997:Time Factors
chemical_list: D007538:Isoniazid