| Autor: |
Weyenga H; Division of Global HIV&TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya., Karanja M; National AIDS & STI Control Program, Ministry of Health, Nairobi, Kenya., Onyango E; National TB Control Program, Ministry of Health, Nairobi, Kenya., Katana AK; Division of Global HIV&TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya., Ng Ang A LW; Division of Global HIV&TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya., Sirengo M; National AIDS & STI Control Program, Ministry of Health, Nairobi, Kenya., Ondondo RO; Division of Global HIV&TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya., Wambugu C; National TB Control Program, Ministry of Health, Nairobi, Kenya., Waruingi RN; University of Nairobi, College of Health Science, Nairobi, Kenya., Muthee RW; National TB Control Program, Ministry of Health, Nairobi, Kenya., Masini E; National TB Control Program, Ministry of Health, Nairobi, Kenya., Ngugi EW; Division of Global HIV&TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya., Shah NS; Division of Global HIV&TB, US CDC, Atlanta, GA, USA., Pathmanathan I; Division of Global HIV&TB, US CDC, Atlanta, GA, USA., Maloney S; Division of Global HIV&TB, US CDC, Atlanta, GA, USA., De Cock KM; Division of Global HIV&TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya. |
| Abstrakt: |
BACKGROUND: TB is the leading cause of mortality among people living with HIV (PLHIV), for whom isoniazid preventive therapy (IPT) has a proven mortality benefit. Despite WHO recommendations, countries have been slow in scaling up IPT. This study describes processes, challenges, solutions, outcomes and lessons learned during IPT scale-up in Kenya. METHODS: We conducted a desk review and analyzed aggregated Ministry of Health (MOH) IPT enrollment data from 2014 to 2018 to determine trends and impact of program activities. We further analyzed IPT completion reports for patients initiated from 2015 to 2017 in 745 MOH sites in Nairobi, Central, Eastern and Western Kenya. RESULTS: IPT was scaled up 75-fold from 2014 to 2018: the number of PLHIV covered increased from 9,981 to 749,890. The highest percentage increases in the cumulative number of PLHIV on IPT were seen in the quarters following IPT pilot projects in 2014 (49%), national launch in 2015 (54%), and HIV treatment acceleration in 2016 (158%). Among 250,069 patients initiating IPT from 2015 to 2017, 97.5% completed treatment, 0.2% died, 0.8% were lost to follow-up, 1.0% were not evaluated, and 0.6% discontinued treatment. CONCLUSIONS: IPT can be scaled up rapidly and effectively among PLHIV. Deliberate MOH efforts, strong leadership, service delivery integration, continuous mentorship, stakeholder involvement, and accountability are critical to program success. |
