• Children
• HIV
• Isoniazid preventive therapy
• Tanzania
• Tuberculosis

• Humans
• Tanzania/epidemiology
• Cross-Sectional Studies
• Isoniazid/therapeutic use
• Female
• Male
• HIV Infections/prevention & control
• Child
• Child, Preschool
• Antitubercular Agents/therapeutic use
• Infant
• Tuberculosis/prevention & control

Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic. Tuberculosis annual risk for children could be as high as 4% particularly in high tuberculosis (TB) prevalent communities. Isoniazid (INH) Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce.

To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos, Nigeria.

This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children < 6 years old enrolled for INH across 32 private hospitals in Lagos, Nigeria. The study took place between July and September 2020. Data was collected on independent variables (age, gender, type of facility, TB screening, dose and weight) and outcome variables (INH outcome and proportion lost to follow up across months 1-6 of INH treatment).

About 53.8% of the participants were female, 95.4% were screened for TB and none was diagnosed of having TB. The participants’ age ranged from 1 to 72 mo with a mean of 36.01 ± 19.67 mo, and 40.2% were between the ages of 1-24 mo. Only 155 (59.2%) of the 262 participants initiated on INH completed the six-month treatment. Cumulatively, 107 (41.0%) children were lost to follow-up at the end of the sixth month. Of the cumulative 107 loss to follow-up while on INH, largest drop-offs were reported at the end of month 2, 52 (49%) followed by 20 (19%), 17 (16%), 11 (10.2%) and 7 (6.5%) at months 3, 4, 5 and 6 respectively. The analysis showed that there was no significant association between age, gender, type of facility and completion of INH treatment (P > 0.005).

This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos, Nigeria. The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early engagement of children on INH and their caregivers in care and across the entire period of treatment.

• Isoniazid
• Child
• Tuberculosis
• Treatment Outcome
• Completion
• Latent tuberculosis
• Dosage

• HIV Infections/therapy
• Humans
• Isoniazid
• Quality Improvement
• South Africa/epidemiology
• Tuberculosis/prevention & control

• D43 TW010131 FIC NIH HHS
• MC_PC_16022 Medical Research Council

A quality improvement (QI) collaborative approach to enhancing integrated HIV-Tuberculosis (TB) services may be effective in scaling up and improving the quality of service delivery. Little is known of the role of organizational contextual factors (OCFs) in influencing the success of QI collaboratives. This study aims to determine which OCFs were associated with improvement in a QI collaborative intervention to enhance integrated HIV-TB services delivery.

This is a nested sub-study embedded in a cluster-randomized controlled trial. Sixteen nurse supervisors (clusters) overseeing 40 clinics were randomized (1:1) to receive QI training and mentorship, or standard of care support (SOC). In the QI arm, eight nurse supervisors and 20 clinics formed a “collaborative” which aimed to improve HIV-TB process indicators, namely HIV testing, TB screening, isoniazid preventive therapy (IPT) initiations, viral load testing, and antiretroviral therapy for TB patients. OCFs measured at baseline were physical infrastructure, key staff, flexibility of clinic hours, monitoring data for improvement (MDI), and leadership support. Surveys were administered to clinic staff at baseline and month 12 to assess perceptions of supportiveness of contexts for change, and clinic organization for delivering integrated HIV-TB services. Linear mixed modelling was used to test for associations between OCFs and HIV-TB process indicators.

A total of 209 clinic staff participated in the study; 97 (46.4%) and 112 (53.6%) from QI and SOC arms, respectively. There were no differences between the QI and SOC arms scores achieved for physical infrastructure (78.9% vs 64.7%; p = 0.058), key staff (95.8 vs 92; p = 0.270), clinic hours (66.9 vs 65.5; p = 0.900), MDI (63.3 vs 65; p = 0.875, leadership support (46.0 vs 57.4; p = 0.265), and perceptions of supportiveness of contexts for change (76.2 vs 79.7; p = 0.128 and clinic organization for delivering integrated HIV-TB services (74.1 vs 80.1; p = 0.916). IPT initiation was the only indicator that was significantly improved in the parent study. MDI was a significantly associated with increasing IPT initiation rates [beta coefficient (β) = 0.004; p = 0.004].

MDI is a practice that should be fostered in public health facilities to increase the likelihood of success of future QI collaboratives to improve HIV-TB service delivery.

Clinicaltrials.gov, NCT02654613. Registered 01 June 2015.

The online version contains supplementary material available at 10.1186/s13012-021-01155-7.

• Cluster-randomized trial
• HIV-TB integration
• Organizational contextual factors
• Quality improvement collaboratives
• South Africa

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There was low IPT initiation among those who were eligible.

Isoniazid Preventive Therapy (IPT) is a proven public health tool to reduce Tuberculosis (TB) among people living with HIV. However, its implementation in most countries is suboptimal. This retrospective study was conducted to determine the coverage and factors associated with IPT initiation to inform program scale up and improve quality of service in Tanzania and elsewhere.

Retrospective cohort study design involving HIV clinics in Dar es Salaam, Iringa and Njombe regions from January 2012 to December 2016.

A total of 171,743 PLHIV were in the cohort from 2012 to 2016. Of these, 166,709 were involved in the analysis. Of those analyzed, 23,970 (14.38%) were ever initiated on IPT. Female sex (aOR = 1.72, 95% CI: 1.13, P < 0.001), obesity (aOR = 1.29, 95% CI:1.20−1.39, P < 0.001), WHO clinical stage II (aOR = 1.48, 95% CI: 1.42−1.55, P < 0.001), enrolment in hospitals (aOR = 1.98, 95% CI: 1.89−2.06, P < 0.001), enrolment in Njombe region (aOR = 1.25: 95% CI: 1.18−1.33, P < 0.001) and enrolment in public health facilities (aOR = 1.93: 95% CI: 1.82−2.04, P < 0.001) were associated with increased IPT uptake. Being on ART (aOR = 0.67, 95% CI: 0.65−0.70, P < 0.001) and severe nutritional status (aOR = 0.72, 95% CI: 0.60−0.88, P < 0.001) were associated with decreased IPT initiation.

Our study documented low IPT initiation in the study area as well as documented factors which enable IPT initiation and those which impair IPT initiation. Strategies are needed to work on barriers and sustain enabling factors to improve IPT coverage.

• Isoniazid preventive therapy
• PLHIV and tuberculosis
• Tanzania