Dickens Onyango, MBChB
Nominated From: University of Washington
Research Site: Kenyatta National Hospital
Research Area: Childhood TB/HIV
Primary Mentor: Grace John-Stewart
Uptake of isoniazid preventive therapy (IPT) and risk factors for IPT non-adherence among HIV-infected children in western Kenya
With optimal adherence, isoniazid preventive therapy (IPT) reduces a child’s risk of developing Tuberculosis (TB) by 60%. There is a paucity of data on the performance of the IPT cascade and adherence to IPT in high TB burden settings. This study seeks to evaluate the IPT cascade and assess adherence to IPT among children living with HIV (CLHIV) in western Kenya. A retrospective cohort analysis of routine data will be used to evaluate the IPT cascade. A prospective cohort study will assess adherence to medication and individual factors associated with adherence. All CLHIV aged below 15 years eligible for IPT from September 2015 through August 2019 will be included in the retrospective IPT cascade evaluation; 100 CLHIV who will be newly initiating IPT and their mothers or caretakers will be enrolled in the prospective study and followed up monthly. Adherence will be assessed through caregiver reports and confirmed using urine dipstick tests and Isoscreen a urine colorimetric test that detects isoniazid metabolites. Staff of Comprehensive Care Centers participating in this study will be included in the evaluation of health facility factors.
The IPT cascade has been identified as a tool for evaluating the implementation of IPT. Data on the performance of the IPT cascade is therefore important in evaluating provision and uptake of TB prevention in CLHIV. Evaluating the cascade helps to identify steps that contribute to losses that may require intervention. Steps in the cascade that have been associated with major losses include: completion of screening, completion of medical evaluation and completion of IPT once started. Data from a large HIV care program in western Kenya reported that 44% of patients on HIV care had inadequate TB screening (being screened in less than 90% of clinical encounters). Since screening for active TB is a pre-requisite to IPT initiation, children who are not screened do not have an opportunity to initiate IPT. A comprehensive evaluation of the IPT cascade among CLHIV has not been conducted. This study will provide data on the performance of the IPT cascade that will guide program implementation. Completion and adherence to the full course (6 months) of medication is important for IPT to be effective. Understanding the current level of adherence using pill counts, biomarkers, and factors contributing to poor adherence will provide accurate information for program improvement. Identified health facility and caregiver barriers to adherence will be useful in improving outcomes of IPT.
Advice for Potential Candidates
The Fogarty fellowship is a great opportunity to learn how to conduct research. The Northern Pacific Global Health consortium has weekly didactic sessions which is a great opportunity to learn from other colleagues. I encourage potential candidates to apply for the fellowship. Once accepted, it is important to work on ethical approval early.