| dc.description.abstract | Background: Children and adolescents contribute 12% to the global TB burden each year. People living with HIV (PLHIV) are 20-37 times more likely to develop active TB disease from latent TB. Prevention of TB among children and adolescents, case detection and management still remains a challenge in most parts of the world. The WHO recommends TB preventive therapy (TPT) for all PLHIV with negative symptom screen for TB disease. Despite this recommendation since 1998, progress in TPT uptake and completion has been slow in many countries and TB prevention in children and adolescents has lagged behind. The Uganda National strategic TB leprosy plan 2019/2020- 2024/2025 intends to increase TPT uptake among PLHIV from 50% to> 90% by 2024/2025. However, studies on uptake and completion of TPT have majorly been done in the adult population but less is known about the factors affecting TPT uptake and completion among children and adolescents. No study has been done in northern Uganda on factors affecting TPT utilization. With new advances in TPT regimen, this study aimed to identify the facilitators and barriers to TPT uptake and completion among Children and adolescents 0-19 years, living with HIV at Gulu Regional Referral Hospital.
Objectives: To determine the uptake and completion rates of TPT, facilitators and barriers among children and adolescents 0-19 years with HIV in care at GRRH.
Methodology: This was an explanatory sequential, mixed methods, cross-sectional study using retrospective chart reviews for the quantitative arm, key informant and in-depth interviews for the qualitative arm. The study was done at Gulu Regional Referral Hospital (GRRH), ART clinic. For the quantitative arm, KOBO collect was used to collect relevant data on TPT uptake and completion among 335 participants consecutively sampled. The qualitative study explored the facilitators and barriers to Uptake and completion of TPT among 21 participants. Key informant interviews were conducted for 5 health workers and 5 peer adolescents purposefully selected. In-depth semi-structured interviews were conducted for 6 caregivers and 5 adolescents, purposively and conveniently selected. Quantitative data was analyzed using STATA version 14.0. Descriptive statistics were used and were summarized in the form of frequencies, means, and standard deviation for normally distributed variables. Uptake of TPT was computed as a percentage of study participants initiated on TPT and completion of TPT was computed as percentage of those initiated on TPT with documented completion, expressed as a percentage. Binary logistic regression was used to assess for any associations between independent variables and uptake, completion of TPT. Qualitative data was analyzed manually and described using thematic analysis.
Results: A total of 335 children and adolescents were recruited in the study. TPT uptake was 99.7% (334/335) and TPT completion was equally 99.7% (333/334). Facilitators of TPT uptake and completion included TPT related health education, fear of TB, counselling, presence of Young adolescent peers (YAPs), community TPT distribution and support from Ministry of health and partners. Barriers to TPT uptake and completion included pill burden, HIV related stigma, inadequate health education, forgetfulness and inadequate monitoring of adherence of TPT.
Conclusion: TPT uptake and completion at Gulu RRH was high and surpassed global and national targets of >90%. There is need to address the few barriers to achieve 100% uptake and completion while other facilities can emulate the facilitators of TPT utilization at GRRH. | en_US |
