Isoniazid Preventative Therapy (IPT) in Swaziland

Improving Uptake and Identifying Critical Factors to Enable Successful Delivery and Treatment Completion

Isoniazid Preventative Therapy (IPT) is a highly effective tuberculosis (TB) prevention method for people living with HIV, with a 33-64% reduction in TB in HIV+ patients who completed IPT. This benefit is enhanced to an 80-95% reduction when IPT is combined with proper anti-retroviral therapy (ART).
 
Despite this clear and tangible benefit, global uptake of IPT has been low with only 10% of eligible patients initiated on IPT, and among those, less than one third had documented completion of the therapy. The Swaziland Ministry of Health endorsed a six-month course of IPT in 2011, but the target of providing IPT to half of those living with HIV was not met as of 2015.
 
The USAID-funded TB CARE II project, in collaboration with PEPFAR, the Kingdom of Swaziland, University Research Co., LLC (URC) and Dartmouth Geisel School of Medicine conducted a prospective cohort study including three IPT delivery models (routine clinic-based, community-based, and peer or family support-based) within five facilities in Swaziland with the aim of improving IPT uptake and assessing the feasibility of providing different models of IPT delivery to allow patients a choice in treatment. The results of the study were presented on November 9, 2017 at the 4th National Health Research Conference.
 
The research conference served as a prime opportunity to disseminate these results and to collect feedback from policymakers, program managers, and implementing partners in defining a universal toolkit for IPT provision. This recently-finalized toolkit provides step-by-step implementation support, describing necessary preparation, systems strengthening components, and quality measures which should be in place for successful IPT provision. The TB CARE II team will work to disseminate this toolkit to the relevant stakeholders for improved IPT implementation in Southern Africa and beyond.

National Health Research Conference IPT Uptake for TB/HIV Patients Study