THE HAGUE, Netherlands – When tuberculosis preventive therapy is delivered with HIV treatment services and patients get a choice in where they access treatment, completion of tuberculosis preventive therapy rises, helping to ensure people living with HIV stay healthy, researchers said here. This model of prevention should be scaled up in TB-HIV high burden settings, researchers said.
Researchers provided 900 patients at five HIV care facilities in eSwatini (formerly Swaziland) with isoniazid preventive therapy to prevent tuberculosis infection and offered participants a choice between receiving the preventive therapy at home or at the health center. Participants received the isoniazid when refilling their HIV medications, and also received education and counseling. Ninety-five percent of participants adhered to the TB preventive regimen and 90 percent successfully completed treatment, Lisa Adams of the Geisel School of Medicine at Dartmouth said.
While participants had a choice to receive TB preventive therapy at home, Adams said, most chose to go to their HIV care center. All participants reported that being offered a choice was important to their treatment completion, while nearly all participants said linking isoniazid delivery with antiretroviral therapy pick-up was key for treatment adherence and completion, Adams said, as it saved time and transportation costs.
“Offering patients choices on how to receive TB care makes them feel more respected,” Adams said. “This can help dismantle perceived stigma against TB and preventive therapy.”
Researchers found that the educational component of the study increased participants’ knowledge about TB and the benefits of taking isoniazid, which in turn encouraged participants to disclose to their friends and family they were taking the preventive therapy, Adams said.
“95 percent told their relatives or friends about [it],” Adams said. “Those with strong social support are more likely to complete treatment.”
Globally, TB remains the biggest killer of people with HIV, less than a quarter of people living with HIV who are in care receive TB preventive therapy.