INH preventive therapy among Thai adult HIV-infected patients

Background. IPT has been shown to reduce the risk of active TB in PPD positive HIV infected individuals. There are limitations to the wide spread use of IPT in developing countries including TST screening process, patient's non-adherence and physician's non-adherence to the IPT guideline. WHO has recommended IPT to non-TST-screened HIV-infected persons in countries with high prevalence of latent TB where TST is not feasible. There is little information whether this approach might affect the patients' adherence and the extent that the physicians in Thailand may adhere to this guideline.; Methods. Nine hundred HIV-infected patients attending HIV hospital-based clinics in Bangkok were enrolled and randomized into TST-screened and non TST-screened groups. 181 PPD-positive and 177 non TST-screened subjects were provided IPT for 6 months. Adherence measured by participant's self-report and pill counts, completed therapy, default and drop out were compared. Determinants for adherence were assessed. Evaluation of adherence to IPT guidelines was accomplished by cross-sectional survey of 107 physicians who provide medical care for HIV-infected patients in Thailand.; Results. Adherence to IPT was 84.5% and 79.7%, by self-report, and 81.8% and 73.9%, by pill counts, in PPD-positive and non TST-screened group respectively [adjusted OR = 1.44 (95% CI: 0.79–2.64) for self-report and 1.53 (95% CI: 0.45–5.26) for pill counts]. The drop out rate in TST-screened group was 19.9% compared to 1.7% in non TST-screened group [OR= 14.67 (95% CI: 4.74–45.29)]. Not having difficulty in coming to clinic, knowing of HIV status more than 30 days, taking IPT at home and 4-week adherence after IPT were significant predictors of adherence. 21.5% of surveyed physicians provided IPT. 87.0% and 34.8% of physicians who provided IPT did not do TST and screening chest X-rays for active TB. Experience with HIV-infected patient's care was significantly associated with providing IPT.; Conclusion. TST screening was not a significant predictor of adherence to IPT but influenced the drop out rate. Selection of the potential recipients for IPT and patient's counseling are needed before providing IPT Educational and training programs for physicians are priorities before implementation of national IPT program.