Yale University

Barriers to Implementation of Isoniazid Prevention Therapy in Rural KwaZulu-Natal, South Africa

Principle Investigator(s):

Funder: NIMH through CIRA's Pilot Project Program
Project period: 06/09/2014 - 06/30/2015
Grant Type: Pilot Project

Abstract Text:

Tuberculosis (TB) remains the leading cause of morbidity and mortality among people living with HIV/AIDS globally. lsoniazid Preventive Therapy (IPT) is a major TB control strategy endorsed by the World Health Organization to reduce TB  incidence, morbidity and mortality among HIV-infected, but global uptake has been slow and treatment adherence and completion poor. Careful evaluation of reasons for poor performance of the IPT strategy at the patient level is limited. We are implementing an innovative project to evaluate a community-based IPT referral strategy in Tugela Ferry, South Africa, an impoverished traditional Zulu area, among the most severely impacted by both HIV and TB in the world.

This project will evaluate uptake, adherence, and treatment completion compared to those already in engaged in HIV care. In addition, we are performing a quantitative evaluation of knowledge, behavior and motivations for IPT. We wish to more deeply and fully understand reasons for IPT implementation success and failure in the clinic setting and here propose adding a patient level qualitative component to this evaluation. In this pilot study, we will perform equal numbers of qualitative interviews with adherent and non-adherent patients in five government clinics in the Tugela Ferry area, where our group has worked for more than a decade.  After obtaining informed consent, we will perform and record semi-structured qualitative interviews by a trained native Zulu speaker. We will transcribe and translate

these and analyze manually and with qualitative software to discern emergent themes about barriers to use of IPT. In combination with collected quantitative data, this study will provide new needed knowledge to inform the development of interventions to improve IPT performance and outcomes. The results will help form the basis for subsequent grant application(s) designed to expand and improve this important TB prevention strategy among people living with HIV.