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Promoting Tuberculosis Preventive Therapy for People Living with HIV in South Africa: Interventions Hindered by Complicated Clinical Guidelines and Imbalanced Patient-Provider Dynamics.

Authors
  • Jarrett, Brooke A1
  • Woznica, Daniel M2
  • Tilchin, Carla3
  • Mpungose, Nthabiseng4
  • Motlhaoleng, Katlego4
  • Golub, Jonathan E5, 6
  • Martinson, Neil A4
  • Hanrahan, Colleen F5
  • 1 Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA. [email protected]
  • 2 Department of Health, Behavior and Society, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
  • 3 Center for Child and Community Health Research, Johns Hopkins University, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
  • 4 Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa. , (South Africa)
  • 5 Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
  • 6 Johns Hopkins School of Medicine, 33 N Broadway, Baltimore, MD, 21205, USA.
Type
Published Article
Journal
AIDS and Behavior
Publisher
Springer-Verlag
Publication Date
Apr 01, 2020
Volume
24
Issue
4
Pages
1106–1117
Identifiers
DOI: 10.1007/s10461-019-02675-6
PMID: 31549265
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Isoniazid preventive therapy (IPT) reduces the risk of active tuberculosis among people living with HIV, but implementation of IPT in South Africa and elsewhere remains slow. The objective of this study was to examine both nurse perceptions of clinical mentorship and patient perceptions of in-queue health education for promoting IPT uptake in Potchefstroom, South Africa. We measured adoption, fidelity, acceptability, and sustainability of the interventions using both quantitative and qualitative methods. Adoption, fidelity, and acceptability of the interventions were moderately high. However, nurses believed they could not sustain their increased prescriptions of IPT, and though many patients intended to ask nurses about IPT, few did. Most patients attributed their behavior to an imbalance of patient-provider power. National IPT guidelines should be unambiguous and easily implemented after minimal training on patient eligibility and appropriate medication durations, nurse-patient dynamics should empower the patient, and district-level support and monitoring should be implemented.

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