High Adherence to Isoniazid for Tuberculosis Preventive Therapy among HIV-infected Persons in Chiang Rai, Thailand (Abstract 470)

1
High Adherence to Isoniazid for Tuberculosis
Preventive Therapy among HIV-infected Persons in
Chiang Rai, Thailand (Abstract 470) Jintana
Ngamvithayapong-Yanai1,2 Sarmwai
Luangjina1 Hideki Yanai2 Pathom
Sawanpanyalert3 1TB/HIV Research Foundation,
Thailand, 2The Research Institute of
Tuberculosis, JATA, Japan, 3Ministry of Public
Health, Thailand Supported by Japanese Foundation
for AIDS Prevention (JFAP) and Ministry of
Health, Welfare and Labor, Japan
2
Abbreviations FGD Focus group discussion INH
Isoniazid IPT Isoniazid Preventive
Therapy for Tuberculosis PWH People with HIV
infection (asymptomatic stage) Objective To
investigate the reasons for a high level of
adherence to the nine-month IPT
3

• Regimen
• Daily 300 mg. Of INH and vitamin B complex for 9
  months (one month supply)
• Clients and setting
• PWH (recruited from blood donors, outpatients
  clinic, anonymous HIV testing clinics and sex
  workers)
• Chiang Rai Regional Hospital
• Definition
• High level of adherence clients who took
  95-100 of INH of the total number of prescribed
  INH pills in 9 months

4
Methods of assessing adherence to IPT 1.
Quantitative assessment -To know the level of
adherence 2. Qualitative assessment - To know
the reasons why a group of PWH could achieve a
high level of adherence although they were in
asymtomatic stage of HIV infection and AIDS
stigma is a problem in the study setting. This
paper discuss about qualitative assessment of
adherence to IPT with special emphasis on high
level of adherence
5

• Methods of assessing adherence to IPT
• 1. Measuring the level of adherence
• pill counting
• Adherence no.of prescribed INH taken by the
  client X 100
• no.of INH
  prescribed for the client
• patient self-report
• measure of appointment kept
• 2. Assessing reasons for high level of adherence
• FGD with the clients who achieved a high level
  of adherence.

6

• Method Selection of FGD participants
• PHA participated in the IPT program 412
• PHA achieved a high level of adherence 42
• PHA participated in the FGD 28
• 1 group of single males
• 2 groups of married males
• 1 group of married females
• 1 group of widowed females

Grouping based on homogeneous attributes
7
Strength and limitation of FGD Limitation Some
participants did not want to open themselves to
other members of the groups due to HIV/AIDS
stigma. Therefore, reasons and methods for
achieving a high level of adherence to IPT of
these participants are not known
8

• Strength and limitation of FGD
• Strength
• The five sessions of FGD were conducted by the
  same moderator -- increase validity of the data
• Interactions among the participants generated
  rich information which can not be obtained by
  individual interview
• Provided rich information from a group of people
  quickly with less cost

9
Recommendations The paper highlights two
methodological aspects of research on
adherence 1. Assessing reasons for good
adherence rather than non-adherence which many
studies have done. The results are applicable to
improve adherence in other settings 2. FGD is a
promising tool for qualitative assessment of
adherence to treatment
10

• Acknowledgement
• Japanese Foundation for AIDS Prevention (JFAP)
  and Ministry of Health, Welfare and Labor, Japan
  supported the study
• Dr.Renu Srismith, Dr.Wat Uthaivoravit and staff
  nurses of Social Preventive Medicine Department,
  Chiang Rai Hospital for approval the study and
  their kind collaboration.
• All participants kindly participated in the
  focus group discussion