Implementation insights into bridging the gaps in isoniazid preventive therapy uptake in adults with HIV

TB remains the leading opportunistic infection among people living with HIV (PLHIV). Isoniazid preventive therapy (IPT) is a key strategy for TB prevention, yet uptake remains suboptimal. This study examined barriers and facilitators to IPT uptake among adult PLHIV and health care providers (HCPs) using the Consolidated Framework for Implementation Research (CFIR).

A cross-sectional, mixed-methods study was conducted at the BJ Government Medical College ART Centre, Pune, India, from May 2022 to July 2023. Qualitative data from 11 in-depth interviews (5 PLHIV, 6 HCPs) were thematically analysed using MAXQDA-2022, and quantitative data from 201 PLHIV were analysed using R.

Among 201 PLHIV, 50% (n = 100) completed IPT, 38% (n = 77) missed doses, and 23% (n = 47) reported side effects. Integrated analysis identified drug stock-outs as the dominant system-level barrier, alongside facility-level constraints such as limited counselling due to staff shortages. Individual-level barriers included fear of side effects and time constraints. Facilitators included effective counselling, family support, perceived preventive benefits, motivation, and trust in providers. HCPs emphasised assertive counselling, routine IPT prescription, and regular follow-up as critical to improving IPT completion.

Ensuring an uninterrupted drug supply, sufficient staffing, and structured counselling is essential for strengthening IPT implementation within HIV programmes.