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Published on: March 30, 2014
Biomarker-confirmed suboptimal adherence to isoniazid preventive therapy among children with HIV in western Kenya
Dickens Otieno Onyango1, Marianne A B van der Sande2,3, Courtney M Yuen4
1Kisumu County Department of Health, Kisumu, Kenya.
Insights
Biomarker-confirmed adherence to isoniazid preventive therapy (IPT) in children with HIV (CLHIV) was suboptimal. Viral nonsuppression and longer IPT duration were linked to nonadherence, suggesting urine dipstick tests could aid clinical monitoring.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Clinical Pharmacology
Background:
- Isoniazid preventive therapy (IPT) is crucial for preventing tuberculosis in children with HIV (CLHIV).
- Accurate assessment of adherence to IPT is essential for treatment efficacy and preventing drug resistance.
- Traditional adherence measures like pill counts and self-reports can be unreliable in pediatric populations.
Purpose of the Study:
- To evaluate the level of biomarker-confirmed adherence to IPT among CLHIV.
- To identify correlates of nonadherence to IPT in this population.
- To assess the utility of urine biomarkers for monitoring IPT adherence in clinical settings.
Main Methods:
- A prospective cohort study involving 97 CLHIV on IPT in public HIV clinics (2019-2020).
- Adherence assessed via pill counts, caregiver/self-reports, and two urine biomarkers (in-house dipstick and Isoscreen) detecting INH metabolites.
- Generalized estimating equations used to analyze correlates of biomarker-confirmed nonadherence.
Main Results:
- Only 39% of CLHIV demonstrated biomarker-confirmed adherence to IPT, compared to 59% self-reporting adherence.
- Viral nonsuppression (aRR=1.65) and the sixth month of IPT use (aRR=2.49) were independently associated with biomarker-confirmed nonadherence.
- The in-house urine dipstick test showed high sensitivity (98.1%) and specificity (94.7%) compared to Isoscreen.
Conclusions:
- Biomarker-confirmed adherence to IPT among CLHIV is suboptimal.
- Adherence is negatively associated with viral nonsuppression and longer duration of IPT.
- Urine dipstick testing presents a promising tool for assessing IPT adherence in clinical practice.
Objectives:
The aim of this study was to assess the level and correlates of biomarker-confirmed adherence to isoniazid (INH) preventive therapy (IPT) among children with HIV (CLHIV).
Design:
This prospective cohort study assessed adherence among CLHIV on IPT in public sector HIV clinics from 2019 through 2020.
Methods:
Adherence was assessed by pill counts or caregiver or self-reports, and urine biomarkers (in-house dipstick and Isoscreen). Both urine biomarker tests detect INH metabolites within 48 h of ingestion. Consistent adherence was defined as having positive results on either biomarker at all visits. Correlates of biomarker-confirmed nonadherence at each visit were evaluated using generalized estimating equations. The in-house dipstick was validated using Isoscreen as the reference.
Results:
Among 97 CLHIV on IPT with adherence assessments, median age was 10 years (IQR 7-13). All were on ART at IPT initiation (median duration 46 months [IQR 4-89]); 81% were virally suppressed (<1000 copies/ml). At all visits, 59% ( n = 57) of CLHIV reported taking at least 80% of their doses, while 39% ( n = 38) had biomarker-confirmed adherence. Viral nonsuppression (adjusted risk ratio [aRR] = 1.65; 95% confidence interval [95% CI] 1.09-2.49) and the sixth month of IPT use (aRR = 2.49; 95% CI 1.34-4.65) were independent correlates of biomarker-confirmed nonadherence at each visit. Sensitivity and specificity of the in-house dipstick were 98.1% ( 94.7 - 99.6%) and 94.7% ( 88.1 - 98.3%) , respectively, versus Isoscreen.
Conclusion:
Biomarker-confirmed adherence to IPT was sub-optimal and was associated with viral nonsuppression and duration of IPT. Urine dipstick testing may be useful in assessing adherence to IPT in clinical care.
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