Barriers to and motivations for the implementation of a treatment programme for latent tuberculosis infection using isoniazid for people living with HIV, in upper northern Thailand

Abstract

Background: Isoniazid Preventive Therapy (IPT) has been recommended by WHO/UNAIDS for people living with HIV (PLWH) since 1993; however the uptake of IPT implementation has been very low globally. This study aims to assess the barriers to and motivations for the implementation of IPT for PLWH in upper northern Thailand, an area with a high tuberculosis (TB) and human immunodeficiency virus (HIV) burden.

Methods: A survey was carried out via self-administered questionnaires mailed to healthcare workers (HCW) in all 95 public hospitals in the upper northern region of Thailand. A reminding phone call, one month after sending the mail, was made.

Results: The response rate from the hospitals was 94% and from the HCW's, 70%. IPT programme was being implemented at only 18 (20%) out of the 89 public hospitals. The main barriers as reported by 144 HCWs working in hospitals without IPT programme, were: (1) unclear direction of national policy (60%), (2) fear of emerging Isoniazid resistant tuberculosis (52%), and (3) fear of poor adherence (30%). The 38 HCWs from hospitals implementing IPT programme, were motivated by (1) knowledge that IPT can prevent TB (63%), (2) the following of national guideline (34%), (3) concern for TB prevention even after the expansion of access to antiretroviral therapy (ART) (32%).

Conclusion and recommendation: To implement an IPT programme for PLWH, giving a clear national policy and straightforward direction are necessary. Furthermore, provision of public health information and updated evidences may enhance HCW's comprehension of benefits and risks of IPT, thus it may increase the IPT programme implementation.

Figure 1

The coverage of IPT implementation in hospitals in upper northern Thailand