"It's about my life": facilitators of and barriers to isoniazid preventive therapy completion among people living with HIV in rural South Africa.
Despite the recent rollout of Isoniazid Preventive Therapy (IPT) to prevent TB in people living with HIV in South Africa, adherence and completion rates are low. To explore barriers to IPT completion in rural KwaZulu-Natal, South Africa, we conducted individual semi-structured interviews among 30 HIV patients who had completed or defaulted IPT. Interview transcripts were analyzed according to the framework method of qualitative analysis. Facilitators of IPT completion included knowledge of TB and IPT, accepting one's HIV diagnosis, viewing IPT as similar to antiretroviral therapy, having social support in the community and the clinic, trust in the healthcare system, and desire for health preservation. Barriers included misunderstanding of IPT's preventive role in the absence of symptoms, inefficient health service delivery, ineffective communication with healthcare workers, financial burden of transport to clinic and lost wages, and competing priorities. HIV-related stigma was not identified as a significant barrier to IPT completion, and participants felt confident in their ability to manage stigma, for example by pretending their medications were for unrelated conditions. Completers were more comfortable communicating with health care workers than were defaulters. Efforts to facilitate successful IPT completion must include appropriate counseling and education for individual patients and addressing inefficiencies within the health care system in order to minimize patients' financial and logistical burden. These patient-level and structural changes are necessary for IPT to successfully reduce TB incidence in this resource-limited setting.
a Department of Medical Education , Icahn School of Medicine at Mount Sinai , New York , USA.
Karen B
0000-0003-3050-4595
KB
Jacobson
b Department of Epidemiology of Microbial Diseases , Yale University School of Public Health , New Haven , USA.
Linda
L
Niccolai
c Research Department , Philanjalo Care Centre , Tugela Ferry , South Africa.
Nonhle
0000-0001-9958-3864
N
Mtungwa
d Church of Scotland Hospital , Tugela Ferry , South Africa.
Anthony P
AP
Moll
e Department of Internal Medicine, Section of Infectious Diseases, AIDS Program , Yale University School of Medicine , New Haven , USA.
Sheela V
0000-0001-7654-4344
SV
Shenoi
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D010349:Patient Compliance; D036301:Qualitative Research; D012424:Rural Population; D057545:Social Stigma; D013019:South Africa / Q000453:epidemiology; D035502:Trust; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology
D000995:Antitubercular Agents; D007538:Isoniazid
HIV/AIDS; Isoniazid preventive therapy; adherence; qualitative methods; tuberculosis