Uptake of Isoniazid Preventive Therapy by Female Sex Workers on HIV Antiretroviral Treatment in Harare, Zimbabwe, 2020

Abstract

To mitigate the dual burden of HIV/AIDS and TB, the World Health Organization recommended the use of Isoniazid Preventive Therapy (IPT) in people living with HIV, household contacts and other people at risk. Despite this recommendation, there is low uptake of IPT globally while data is scarce on the uptake of IPT by female sex workers (FSWs), a key population group among people with HIV in Zimbabwe. The uptake of IPT by FSWs living with HIV has not been assessed in Harare. This study determined the proportion of IPT uptake and the associated factors in the FSW key population group at PSI Zimbabwe New Africa House Clinic. This mixed methods study reviewed electronic medical records of 296 randomly selected FSWs initiated on HIV antiretroviral treatment between 2017 and 2020 and triangulated the findings with qualitative interviews of the same FSWs. Nine key informant healthcare providers were purposively selected for interviews. Univariate and multivariate logistic regression analyses in Epi Info 7 were performed to determine the factors associated with IPT uptake. The overall uptake was 60.1% (n=178). Knowledge of the benefits of the IPT prophylaxis, 54.5% (n = 97) was the most cited reason for taking it up whilst the reasons cited for poor IPT uptake included lack of IPT information provision, lack of IPT awareness and IPT prophylaxis not offered, reported by 64.4% (n = 76). From the key informants’ thematic analysis, outcome of low IPT uptake status was caused by erratic supply and absence of adequate pyridoxine stocks for the IPT side effects management, lack of IPT awareness to the public as a whole as well as fear of pill burden and IPT side effects by the FSWs. On univariate analysis, demographic variables statistically significant were marital status [OR = 0.3928 p 0.01], level of education [OR = 0.6673 p 0.0473] and employment status [OR = 1.2539 p 0.04]. Antiretroviral status variables including WHO stage [OR = 0.5688 p 0.01], latest viral load result [OR = 0.8410 p 0.03], TB screened [OR = 2.7689 p 0.00] and tested for MTB [OR = 2.1164 p 0.00] were statistically significant. Health service delivery variables namely heard about IPT [OR = 25.3066 p 0.00], IPT information source [OR = 2.3024 p 0.00], definition of IPT [OR = 4.3510 p 0.00], information known about IPT course duration [OR = 14.1218 p 0.00], offered IPT [OR = 104.0407 p 0.00] and IPT side effects [OR = 0.0033 p 0.00] had a statistically significant association with IPT uptake. On multivariate analysis, latest viral load result [aOR = 0.1025 p 0.04] and IPT side effects [aOR = 0.0002 p 0.00] respectively were statistically significant predictors of uptake of IPT services. These findings indicate the need to strengthen IPT uptake by female sex workers in Harare. Health education provision demystifying IPT side effects and the importance of reporting of any IPT side effects to both the FSWs and community at large is a crucial measure in ensuring improvement in IPT uptake.