Isoniazid Prevention Therapy (IPT) rolled out in PopART study intervention sites
The PopART study embraces the “Test, Treat, and stop HIV approach”, this comes with key interventions for Tuberculosis prevention and treatment which reduce TB morbidity and mortality in people living with HIV, in addition to the provision of Anti-retroviral treatment (ART) for all clients that test HIV positive.
As PopART study year 2 gets underway, one of the activities in the intervention package is Tuberculosis screening, diagnosis, and treatment (linkage to care) in the house-to-house delivery of the PopART HIV prevention and treatment package.
According to WHO (2011), TB is the most common illness among people living with HIV, including those on ART, and claims nearly 1 in 4 deaths among people living with HIV.
In PopART year 2, case finding of TB and offering of Isoniazid Prevention Therapy (IPT) has been intensified. This is being done through the CHiP teams in the intervention communities by screening everyone enrolled in the PopART study at household level and IPT provision at health facility level.
This necessitated that all the PopART sites undergo orientation on new IPT guidelines. At all PopART sites, health facility and PopART staff were oriented on IPT implementation. CHiPs were trained on good sputum collection techniques, and monitoring is on-going. The challenge in IPT implementation is low availability of Isoniazid. However, this is being addressed.
Early detection of TB in PopART study is strengthened by the introduction of the use of Gene-Xpert in 2014 by Zambart, in partnership with the Ministry of Health and Ministry of Community Development, Mother and Child Health (MCDMCH).
All PopART study clients linked to care for ART and who are found to be MTB negative through the symptom screening or Gene-Xpert sputum examination will be immediately started on IPT as a TB prophylaxis. This will contribute to more clients being treated for TB and prevention of TB transmission to other community members.
IPT is the use of Isoniazid to treat patients who are infected with MTB, but do not have active disease, a condition known as latent TB infection. For these patients, a six month course of INH significantly reduces the risk of progression from latent to active TB. Providing IPT for HIV patients does not only reduce the patient’s risk but also helps to lessen TB transmission to others.
In Kabwe, 55 Zambart Staff, 8 Makululu and 12 Ngungu Clinic staff were oriented on IPT. For Makululu clinic, they have been implementing IPT for children since June, 2014. Zambart partnered with Kabwe DCMO’S office that provided one facilitator, this was to ensure ownership of the program, sustainability and easy monitoring of the IPT implementation process.
At Shampande clinic in Choma, 35 clinic and PopART staff were oriented on IPT guidelines and started implementing the IPT programme at both the ART and Mother and Child Health departments.
PopART study Intervention Manager for VMMC and TB, Ephraim Sakala, cautioned the trainees on the importance of following the guidelines. He emphasisedthat people with active or suspected TB, alcoholics, hypersensitivity to INH, liver disease, peripheral neuropathy and history of convulsion should not be given INH.
Naomi Tembo, the Choma district TB Focal Point Person, attended the orientation expressed satisfaction with the orientation program.
“I wish clinical staff from other clinics attended this orientation also,” she said.
In Lusaka, at Kanyama First Level Hospital, 93 PopART staff and 42 medical staff were oriented separately in IPT use in July, 2015. Focus was on the guidelines and target population. Before the orientation, only two TB treatment supporters were trained in IPT use in children.
“This finding prompted us to target staff in ART, MCH and TB departments. The staff included a Doctor, Clinical Officers, Nurses and Lay counsellors/Peer Educators/TB Treatment Supporters,” explained Mr Sakala. It was agreed that Isoniazid would be ordered the same way other essential TB drugs were ordered for the hospital.
Following the orientation, sensitization sessions on IPT were held each morning at the ART clinic for a week by lay counsellors. Kanyama, an arm B site, is the second largest site under the PopART study in Zambia.