Isoniazid Preventive Therapy and the Development of TB Among People Living with HIV in Nigeria
Date of Conferral
10-25-2023
Degree
Ph.D.
School
Public Health
Advisor
Shuey Schumaker
Abstract
Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a growing syndemic, with TB accounting for two-thirds of deaths among people living with HIV (PLHIV). Close to 1,000,000 new TB infections occurred among PLHIV in 2019, and 84% of 251,000 PLHIV deaths from TB in the same year occurred in Africa. A 6-month isoniazid preventive therapy (IPT) course offers PLHIV four years of protection. The waning and inconsistency in the reported protective effect and the poor understanding of the factors associated with IPT completion aligned with the disproportionate impact of TB on PLHIV. This secondary analysis grounded in Andersen’s health behavior model analyzed 446 PLHIV samples in three states of Nigeria to assess the relationship between the number of years post-IPT completion and TB development among PLHIV. The predictive influence of predisposing, enabling, and need factors on IPT completion was explored. PLHIV were screened three times before IPT completion, demonstrating adherence to clinical monitoring and treatment guidelines. The IPT completion rate was 92%. The hypothesis on the association between the number of years of post-IPT completion and TB development was rejected, chi-square X2 (4, N = 408) = .000, p = .001. The IPT protective effect increased. PLHIV who completed IPT had a significant CD4+ T cell mean rise difference, p < .001. The TB incidence and prevalence among PLHIV enrolled in IPT were 3.7 per 10,000 persons-years and 0.24%, respectively. Marital status, educational level, and CD4+ T cell did not influence IPT completion. A structured IPT program will reduce PLHIV and general population TB infections and abort latent TB infection transition to full TB, which are anticipated to positively impact the 2030 end TB strategy plan.
Recommended Citation
Egesimba, Ginika Nwanosike, "Isoniazid Preventive Therapy and the Development of TB Among People Living with HIV in Nigeria" (2023). Walden Dissertations and Doctoral Studies. 15013.
https://scholarworks.waldenu.edu/dissertations/15013
