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Promoting Tuberculosis Preventive Therapy for People Living with HIV in South Africa: Interventions Hindered by Complicated Clinical Guidelines and Imbalanced Patient-Provider Dynamics

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Abstract

Isoniazid preventive therapy (IPT) reduces the risk of active tuberculosis among people living with HIV, but implementation of IPT in South Africa and elsewhere remains slow. The objective of this study was to examine both nurse perceptions of clinical mentorship and patient perceptions of in-queue health education for promoting IPT uptake in Potchefstroom, South Africa. We measured adoption, fidelity, acceptability, and sustainability of the interventions using both quantitative and qualitative methods. Adoption, fidelity, and acceptability of the interventions were moderately high. However, nurses believed they could not sustain their increased prescriptions of IPT, and though many patients intended to ask nurses about IPT, few did. Most patients attributed their behavior to an imbalance of patient-provider power. National IPT guidelines should be unambiguous and easily implemented after minimal training on patient eligibility and appropriate medication durations, nurse-patient dynamics should empower the patient, and district-level support and monitoring should be implemented.

Resumen

La terapia preventiva con Isoniazida (TPI) reduce el riesgo de tuberculosis activa en personas con VIH, pero la implementación de TPI en Sudáfrica y otros lugares es lenta. El objetivo de este estudio fue examinar las percepciones tanto de enfermeras de un programa de mentores clínicos y de pacientes de un programa de educación para la salud impartido en la fila para promover la TPI en Potchefstroom, Sudáfrica. Medimos la adopción, aceptabilidad y sostenibilidad de la intervención usando métodos cuantitativos y cualitativos. La adopción, adherencia, y aceptabilidad de la intervención fueron moderadamente altas. Sin embargo, las enfermeras pensaron que el incremento en la prescripción de TPI no era sostenible, además, aunque muchos pacientes pensaron en preguntarle a las enfermeras acerca de TPI, pocos lo hicieron. La mayoría de los pacientes atribuyeron su conducta a un desequilibrio de poder en la relación paciente-proveedor. Las guías nacionales de TPI deberían ser claras y fáciles de implementar tras un entrenamiento mínimo acerca de la elegibilidad de pacientes y duración apropiada de tratamiento, la dinámica de paciente-enfermera debe empedrar al paciente, y apoyo y vigilancia deben ser implementados a nivel distrital.

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Acknowledgements

The authors would like to thank the study participants who donated their time. This study was funded by a 2016 Global Health Experience Field Placement fellowship from the Johns Hopkins Center for Global Health. It was also funded by a 2016 developmental Grant from the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189) that is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent official views of the NIH.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA

    Brooke A. Jarrett, Jonathan E. Golub & Colleen F. Hanrahan

  2. Department of Health, Behavior and Society, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA

    Daniel M. Woznica

  3. Center for Child and Community Health Research, Johns Hopkins University, 5200 Eastern Avenue, Baltimore, MD, 21224, USA

    Carla Tilchin

  4. Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa

    Nthabiseng Mpungose, Katlego Motlhaoleng & Neil A. Martinson

  5. Johns Hopkins School of Medicine, 33 N Broadway, Baltimore, MD, 21205, USA

    Jonathan E. Golub

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Jarrett, B.A., Woznica, D.M., Tilchin, C. et al. Promoting Tuberculosis Preventive Therapy for People Living with HIV in South Africa: Interventions Hindered by Complicated Clinical Guidelines and Imbalanced Patient-Provider Dynamics. AIDS Behav 24, 1106–1117 (2020). https://doi.org/10.1007/s10461-019-02675-6

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