Can isoniazid preventive therapy be scaled up rapidly? Lessons learned in Kenya, 2014-2018

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• HIV/AIDS Management

Background:

• Tuberculosis (TB) is a leading cause of death in people living with HIV (PLHIV).
• Isoniazid preventive therapy (IPT) significantly reduces mortality in PLHIV but faces slow scale-up globally.
• This study examines the processes and outcomes of IPT scale-up in Kenya.

Purpose of the Study:

• To describe the processes, challenges, solutions, and outcomes of scaling up IPT in Kenya.
• To analyze trends and impact of IPT program activities from 2014 to 2018.
• To evaluate IPT completion rates and patient outcomes.

Main Methods:

• Desk review of program documents and Ministry of Health (MOH) IPT enrollment data (2014-2018).
• Analysis of aggregated IPT enrollment data to determine trends.
• Analysis of IPT completion reports from 745 MOH sites for patients initiated between 2015-2017.

Main Results:

• IPT coverage for PLHIV in Kenya increased 75-fold from 9,981 to 749,890 between 2014 and 2018.
• Significant increases in PLHIV on IPT followed pilot projects, national launch, and HIV treatment acceleration initiatives.
• Among 250,069 patients initiating IPT (2015-2017), 97.5% completed treatment, with low rates of death (0.2%) and loss to follow-up (0.8%).

Conclusions:

• Rapid and effective scale-up of IPT among PLHIV is achievable.
• Key factors for successful IPT scale-up include deliberate Ministry of Health efforts, strong leadership, integrated service delivery, mentorship, stakeholder involvement, and accountability.