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      Factors affecting the acceptability of isoniazid preventive therapy among healthcare providers in selected HIV clinics in Nairobi County, Kenya: a qualitative study

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          Abstract

          Objective

          Despite being globally recommended as an effective intervention in tuberculosis (TB) prevention among people living with HIV, isoniazid preventive therapy (IPT) implementation remains suboptimal, especially in sub-Saharan Africa. This study explored the factors influencing the acceptability of IPT among healthcare providers in selected HIV clinics in Nairobi County, Kenya, a high HIV/TB burden country.

          Design

          A qualitative study was conducted using in-depth interviews with healthcare providers in selected HIV clinics. All conversations were audio recorded, transcribed verbatim and analysed using a thematic approach.

          Setting

          The study was conducted in the HIV clinics of three purposefully selected public healthcare facilities in Nairobi County, Kenya between February 2017 and April 2017.

          Participants

          Eighteen purposefully selected healthcare providers (clinicians, nurses, pharmacists and counsellors) working in the HIV clinics participated in the study.

          Results

          Provider acceptability of IPT was influenced by factors relating to the organisational context, provider training on IPT and their perception on its efficacy, length and clarity of IPT guidelines and standard operation procedures, as well as structural factors (policy, physical and work environment). Inadequate high-level commitment and support for the IPT programme by programme managers and policy-makers were found to be the major barriers to successful IPT implementation in our study context.

          Conclusion

          This study provides insight into the complexity of factors affecting the IPT implementation in Kenya. Ensuring optimal acceptability of IPT among healthcare providers will require an expanded depth of engagement by policy-makers and IPT programme managers with both providers and patients, as well as on-the-job design specific actions to support providers in implementation. Such high-level commitment and support are consequently essential for quality delivery of the intervention.

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          Most cited references12

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          Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation.

          If we keep on doing what we have been doing, we are going to keep on getting what we have been getting. Concerns about the gap between science and practice are longstanding. There is a need for new approaches to supplement the existing approaches of research to practice models and the evolving community-centered models for bridging this gap. In this article, we present the Interactive Systems Framework for Dissemination and Implementation (ISF) that uses aspects of research to practice models and of community-centered models. The framework presents three systems: the Prevention Synthesis and Translation System (which distills information about innovations and translates it into user-friendly formats); the Prevention Support System (which provides training, technical assistance or other support to users in the field); and the Prevention Delivery System (which implements innovations in the world of practice). The framework is intended to be used by different types of stakeholders (e.g., funders, practitioners, researchers) who can use it to see prevention not only through the lens of their own needs and perspectives, but also as a way to better understand the needs of other stakeholders and systems. It provides a heuristic for understanding the needs, barriers, and resources of the different systems, as well as a structure for summarizing existing research and for illuminating priority areas for new research and action.
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            Tuberculosis and HIV Co-Infection

            Tuberculosis (TB) and HIV co-infections place an immense burden on health care systems and pose particular diagnostic and therapeutic challenges. Infection with HIV is the most powerful known risk factor predisposing for Mycobacterium tuberculosis infection and progression to active disease, which increases the risk of latent TB reactivation 20-fold. TB is also the most common cause of AIDS-related death. Thus, M. tuberculosis and HIV act in synergy, accelerating the decline of immunological functions and leading to subsequent death if untreated. The mechanisms behind the breakdown of the immune defense of the co-infected individual are not well known. The aim of this review is to highlight immunological events that may accelerate the development of one of the two diseases in the presence of the co-infecting organism. We also review possible animal models for studies of the interaction of the two pathogens, and describe gaps in knowledge and needs for future studies to develop preventive measures against the two diseases.
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              HIV-TB co-infection: epidemiology, diagnosis & management.

              HIV/AIDS pandemic has caused a resurgence of TB, resulting in increased morbidity and mortality worldwide. HIV and Mycobacterium tuberculosis have a synergistic interaction; each accentuates progression of the other. Clinical presentation of TB in early HIV infection resembles that observed in immunocompetent persons. In late HIV infection, however, TB is often atypical in presentation, frequently causing extrapulmonary disease. These factors coupled with low sputum smear-positivity, often result in a delayed diagnosis. HIV-infected patients respond well to the standard 6-month antituberculosis treatment regimens, although mortality is high. Antituberculosis treatment is complicated by frequent drug-interactions with highly active antiretroviral therapy (HAART) and adverse drug reactions are more common among HIV-infected patients. Guidelines for the management of patients co-infected with HIV and TB are still evolving. Timely institution of antituberculosis treatment using the directly observed treatment, short-course (DOTS) strategy and HAART markedly improves the outcome of HIV-infected patients with TB.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                19 December 2018
                : 8
                : 12
                : e024286
                Affiliations
                [1 ] departmentResearch unit , African Population and Health Research Center , Nairobi, Kenya
                [2 ] departmentSchool of Public Health , University of the Witwatersrand , Johannesburg, South Africa
                [3 ] departmentResearch Uptake & Policy Engagement Unit , Partnership for African Social & Governance Research , Nairobi, Kenya
                [4 ] departmentPublic Health department , College of Health Sciences, University of Nairobi , Nairobi, Kenya
                [5 ] departmentDepartment of Planning Research & Statistics , National Primary Health Care Development Agency , Abuja, Nigeria
                [6 ] departmentResearch unit , Nigerian Institute of Medical Research (NIMR) , Lagos, Nigeria
                Author notes
                [Correspondence to ] Mr Elvis Omondi Achach Wambiya; eowambiya@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-4149-3417
                Article
                bmjopen-2018-024286
                10.1136/bmjopen-2018-024286
                6303693
                30573488
                f738ceda-13e0-480e-b248-0ae8d6d63f76
                © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 18 May 2018
                : 05 November 2018
                : 09 November 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004423, World Health Organization;
                Categories
                Infectious Diseases
                Research
                1506
                1706
                1330
                Custom metadata
                unlocked

                Medicine
                hiv & aids,tuberculosis,qualitative research,public health
                Medicine
                hiv & aids, tuberculosis, qualitative research, public health

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