PMID- 35927793 OWN - NLM STAT- MEDLINE DCOM- 20220808 LR - 20240205 IS - 1758-2652 (Electronic) IS - 1758-2652 (Linking) VI - 25 IP - 8 DP - 2022 Aug TI - Drop-offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015-2019. PG - e25939 LID - 10.1002/jia2.25939 [doi] LID - e25939 AB - INTRODUCTION: Isoniazid preventive therapy (IPT) can reduce the risk of tuberculosis (TB) in children living with HIV (CLHIV), but data on the outcomes of the IPT cascade in CLHIV are limited. METHODS: We evaluated the IPT cascade among CLHIV aged <15 years and newly enrolled in HIV care in eight HIV clinics in western Kenya. Medical record data were abstracted from September 2015 through July 2019. We assessed the proportion of CLHIV completing TB symptom screening, IPT eligibility assessment, IPT initiation and completion. TB incidence rate was calculated stratified by IPT initiation and completion status. Risk factors for IPT non-initiation and non-completion were assessed using Poisson regression with generalized linear models. RESULTS: Overall, 856 CLHIV were newly enrolled in HIV care, of whom 98% ([95% CI 97-99]; n = 841) underwent screening for TB symptoms and IPT eligibility. Of these, 13 (2%; 95% CI 1-3) were ineligible due to active TB and 828 (98%; 95% CI 97-99) were eligible. Five hundred and fifty-nine (68%; 95% CI 64-71) of eligible CLHIV initiated IPT; median time to IPT initiation was 3.6 months (interquartile range [IQR] 0.5-10.2). Overall, 434 (78%; 95% CI 74-81) IPT initiators completed. Attending high-volume HIV clinics (aRR = 2.82; 95% CI 1.20-6.62) was independently associated with IPT non-initiation. IPT non-initiation had a trend of being higher among those enrolled in the period 2017-2019 versus 2015-2016 (aRR = 1.91; 0.98-3.73) and those who were HIV virally non-suppressed (aRR = 1.90; 95% CI 0.98-3.71). Being enrolled in 2017-2019 versus 2015-2016 (aRR = 1.40; 1.01-1.96) was independently associated with IPT non-completion. By 24 months after IPT screening, TB incidence was four-fold higher among eligible CLHIV who never initiated (8.1 per 1000 person years [PY]) compared to CLHIV who completed IPT (2.1 per 1000 PY; rate ratio [RR] = 3.85; 95% CI 1.08-17.15), with a similar trend among CLHIV who initiated but did not complete IPT (8.2/1000 PY; RR = 4.39; 95% CI 0.82-23.56). CONCLUSIONS: Despite high screening for eligibility, timely IPT initiation and completion were suboptimal among eligible CLHIV in this programmatic cohort. Targeted programmatic interventions are needed to address these drop-offs from the IPT cascade by ensuring timely IPT initiation after ruling out active TB and enhancing completion of the 6-month course to reduce TB in CLHIV. CI - (c) 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. FAU - Onyango, Dickens Otieno AU - Onyango DO AUID- ORCID: 0000-0002-1634-0531 AD - Kisumu County Department of Health, Kisumu, Kenya. AD - Institute of Tropical Medicine, Antwerp, Belgium. AD - Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. FAU - van der Sande, Marianne A B AU - van der Sande MAB AD - Institute of Tropical Medicine, Antwerp, Belgium. AD - Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. FAU - Yuen, Courtney M AU - Yuen CM AD - Harvard Medical School, Boston, Massachusetts, USA. FAU - Mecha, Jerphason AU - Mecha J AD - Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. FAU - Matemo, Daniel AU - Matemo D AD - Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. FAU - Oele, Elizabeth AU - Oele E AD - Kisumu County Department of Health, Kisumu, Kenya. FAU - Kinuthia, John AU - Kinuthia J AD - Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. AD - Department of Global Health, University of Washington, Seattle, Washington, USA. FAU - John-Stewart, Grace AU - John-Stewart G AD - Department of Global Health, University of Washington, Seattle, Washington, USA. AD - Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA. AD - Department of Epidemiology, University of Washington, Seattle, Washington, USA. AD - Department of Pediatrics, University of Washington, Seattle, Washington, USA. FAU - LaCourse, Sylvia M AU - LaCourse SM AUID- ORCID: 0000-0002-9809-5997 AD - Department of Global Health, University of Washington, Seattle, Washington, USA. AD - Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA. LA - eng GR - D43 TW011817/TW/FIC NIH HHS/United States GR - K23 AI120793/AI/NIAID NIH HHS/United States GR - D43 TW009345/TW/FIC NIH HHS/United States GR - UL1 TR000423/TR/NCATS NIH HHS/United States GR - R25 TW009345/TW/FIC NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - Switzerland TA - J Int AIDS Soc JT - Journal of the International AIDS Society JID - 101478566 RN - 0 (Antitubercular Agents) RN - V83O1VOZ8L (Isoniazid) SB - IM MH - Antitubercular Agents/therapeutic use MH - Child MH - *HIV Infections/complications/drug therapy/epidemiology MH - Humans MH - Isoniazid/therapeutic use MH - Kenya/epidemiology MH - *Tuberculosis/diagnosis/drug therapy/epidemiology PMC - PMC9352867 OTO - NOTNLM OT - Mycobacterium tuberculosis infection OT - cascade OT - children OT - human immunodeficiency virus OT - isoniazid OT - preventive therapy COIS- The authors have no competing interests to declare. EDAT- 2022/08/06 06:00 MHDA- 2022/08/09 06:00 PMCR- 2022/08/04 CRDT- 2022/08/05 00:22 PHST- 2021/10/23 00:00 [received] PHST- 2022/05/17 00:00 [accepted] PHST- 2022/08/05 00:22 [entrez] PHST- 2022/08/06 06:00 [pubmed] PHST- 2022/08/09 06:00 [medline] PHST- 2022/08/04 00:00 [pmc-release] AID - JIA225939 [pii] AID - 10.1002/jia2.25939 [doi] PST - ppublish SO - J Int AIDS Soc. 2022 Aug;25(8):e25939. doi: 10.1002/jia2.25939.