ASSESSMENT OF IMPLEMENTATION OF ISONIAZID PREVENTIVE THERAPY, ADHERENCE AND ITS DETERMINANTS IN PUBLIC HEALTH FACILITIES OF DIRE DAWA CITY ADMINISTRATION

Abstract

Background: Scientific information on the number of IPT beneficiaries, their rate of adherence visà- vis determinants of adherence is scarce in Ethiopia. Hence, it was practically impossible to discuss whether the preventive therapy was reaching those who were in need of the service or whether it was being rationally used. Objective: The main objective of the study was to assess the implementation of IPT, adherence to the treatment and its determinants. Methods: This cross-sectional study was conducted in five ART service providing public health facilities of Dire Dawa City Administration from April to May, 2009. Primary data was collected through patient exit interviews of 238 PLHIV who were on IPT and in-depth interview of 4 health service managers, while secondary data was collected from health facilities through observation. SPSS V.16 was used for data anlysis. Descriptive statistics was generated for socio-demographic and other quantitative data while thematic analysis was conducted for qualitative data. Binary logistic regression tests were performed to analyze the degree of association between the dependent and the independent variables. Odds ratio was determined using cross-tabulation on respondents’ age and sex to analyze association with adherence level. Results: In general, health facilities’ organizational capacity was assessed to be good whereas there were observed differences among the facilities in patient load and service availability. However, IPT service coverage and adherence level were generally low in the studied health facilities with only 179 (37.3%) individuals receiving INH among the eligible 480 with aggregated treatment adherence level of respondents being 84.8% and self-reported full adherence level being 78.2%. Being away from home, forgetfulness and running out of pills were identified as the major reasons for missing INH doses, which implies that the most important factors for adherence were usually those that are related to the patients themselves; and contributions of health service and community level factors to non-adherence were minimal. Socio-demographic and patient care variables were not found to have significant association with the level of adherence. Conclusion and recommendations: Attitude and follow-up were found to be the main challenges for better service utilization and appropriate adherence. Therefore, improving attitude, strengthening service provision follow up, designing and implementing appropriate strategies that strengthen adherence counseling and patients follow up are recommended.