India accounts for 26% of the TB cases worldwide, and almost 40% of its population is infected with latent TB. The country ranks third in the share of HIV burden and has an estimated 71,000 HIV-TB co-infection cases. Nearly 25% of all deaths among people living with HIV (PLHIV) in India have been estimated to be due to TB. Prevention of TB disease is a critical component of the National Strategic Plan for TB elimination in India, and scaling up Isoniazid Preventive Therapy (IPT) could accelerate the rate of decline in TB incidence. In 2017, India rolled out a nationwide IPT policy, but implementation has been challenging and coverage has been low. IPT coverage among eligible PLHIV in 2019 was only 43-45%.

Studying the barriers to and facilitators for IPT uptake serves a public health need for the prevention of TB among adult PLHIV in India and similar HIV-TB burdened settings. This PEER project investigated the barriers to IPT uptake among adult PLHIV and sought to identify possible strategies and facilitators to improve the uptake of IPT. The project also included a mentoring and training component for young female researchers.

Final Summary of Project Activities

The researchers conducted in-depth interviews with adult PLHIV and healthcare providers, followed by more than 200 semi-structured interviews with only PLHIV to assess factors influencing IPT uptake. The in-depth interviews identified time constraints, IPT side effects, and limited counseling as barriers among PLHIV, while healthcare providers highlighted challenges in TB screening, staff shortages, and medication stockouts. Facilitating factors for PLHIV included TB/IPT knowledge, perceived benefits, self-motivation, and trust in healthcare workers, while the providers reported definitive IPT prescription and assertive counseling.

The semi-structured interviews indicated an IPT uptake of 45%, with 59% reporting missed doses and 24% experiencing side effects. Major barriers included frequent drug stockouts, adverse reactions, lack of motivation, and forgetfulness. Facilitators included counseling by HCPs, self-motivation, and support from family and friends.

Final data analysis is ongoing, and the PEER team expects to submit findings to a journal. Meanwhile, the researchers presented their findings at the 2023 International AIDS Society Conference and at a dissemination event at the tertiary care TB Chest Hospital at Aundh, Pune, India. The dissemination event drew more than 50 participants from the national TB and HIV programs across the city. Policy recommendations from this study include strengthening the healthcare system by ensuring adequate staffing and periodic training sessions, maintaining a steady supply of IPT medicines, increasing awareness of IPT benefits, and providing counseling about its side effects.

As for the mentorship component, the mentees received training in clinical research principles, including research ethics, study design, data collection and management, statistical analysis, and interpretation of results. They were actively involved in various aspects of the research project, such as design of the interview guide and tools, participant recruitment, data collection, data entry, data cleaning, and data analysis.