Successful Implementation of Isoniazid Preventive Therapy at a Pediatric HIV Clinic in Tanzania

Abstract Background: In accordance with international guidance for tuberculosis (TB) prevention, the Tanzanian Ministry of Health recommends isoniazid preventive therapy (IPT) for children aged 12 months and older who are living with HIV. Concerns about tolerability, adherence, and potential mistreatment of undiagnosed TB with monotherapy have limited uptake of IPT globally, especially among children, in whom diagnostic confirmation is challenging. We assessed pediatric IPT implementation and adherence at a pediatric HIV clinic in Tanzania. Methods: Eligible HIV-infected children aged 1-15 years receiving care at the DarDar Pediatric Program in Dar es Salaam who screened negative for TB disease signs and symptoms were offered a 6-month regimen of daily isoniazid. Patients could choose to receive their IPT via facility- or community-based care. Isoniazid was dispensed with the child’s antiretroviral therapy every 1-3 months. IPT adherence and treatment completion was determined by pill counts, appointment attendance, and self-report. Patients underwent TB symptom screening at every visit. Results: We enrolled 66 children between July and December 2017. No patients/caregivers declined IPT. Most participants were female (n=43, 65.1%) and the median age was 11 years (interquartile range [IQR] 8, 13). 63 (95.5%) participants chose the facility-based model; due to the small number of participants who chose the community-based model, valid comparisons between the two groups could not be made. Forty-nine participants (74.2%) completed IPT within 10 months. Among the remaining 17, most (n=11, 64.7%) had IPT discontinued by their provider due to adverse drug reactions; 5 patients (29.4%) lacked documentation of completion. Of those who completed IPT, the average monthly adherence was 98.0%. None of the participants were diagnosed with TB while taking IPT or during a median of 4 months of follow-up. Conclusions: High adherence and treatment completion rates can be achieved when IPT is integrated into routine, self-selected facility-based pediatric HIV care. Improved record-keeping may yield even higher completion rates. IPT was well tolerated and no cases of TB were detected. IPT for children living with HIV is feasible and should be implemented throughout Tanzania and in similar high TB/HIV-burden settings.