title: Health system challenges: An obstacle to the success of isoniazid preventive therapy.
abstract: BACKGROUND
  The researchers identified infection with HIV as the strongest risk factor in the reactivation of latent tuberculosis (TB) infection or progression to active disease. Isoniazid preventive therapy (IPT) is one of the interventions recommended by the World Health Organization and the South African (SA) National Department of Health to prevent progression to active TB disease in people living with HIV. Adherence to IPT is therefore the responsibility of healthcare clients and clinicians.
  
  
  OBJECTIVE
  To describe the incidence of TB among clients who received IPT, rates of completing and not completing IPT among those who started it, and the reasons for non-completion.
  
  
  METHODS
  A quantitative, non-experimental, descriptive retrospective cohort study was undertaken. The clinic records of 104 HIV-positive adults receiving care at a clinic in SA who started IPT between 1 July 2010 and 30 November 2011 were analysed.
  
  
  RESULTS
  Sixty-six of 104 study respondents (63.5%) completed the IPT course. None of the respondents who completed IPT was diagnosed with TB, and 86.8% of the respondents who did not complete the programme did so because of the poor quality of healthcare they received, and not by their own choice.
  
  
  CONCLUSIONS
  The study results strengthened the findings of similar local and international studies that IPT is advantageous in the prevention of TB. The finding that so many patients did not complete the programme as a result of drug dispensing or prescription problems is alarming, and revealed a major shortcoming in the healthcare system.
authors.affiliation: Department of Internal Medicine, Dr George Mukhari Academic Hospital, Garankuwa, Pretoria, South Africa. docokoli@yahoo.com.
authors.forename: E I
authors.initials: EI
authors.lastname: Okoli
authors.forename: L
authors.initials: L
authors.lastname: Roets
mesh_terms: D000995:Antitubercular Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D060085:Coinfection; D003695:Delivery of Health Care / Q000592:standards*; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007538:Isoniazid / Q000600:supply & distribution / Q000627:therapeutic use*; D059012:Lost to Follow-Up; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid