Barriers to Implementation of Isoniazid Preventive Therapy in HIV Clinics: A Qualitative Study

Though isoniazid preventive therapy (IPT) has been shown to reduce TB incidence among people with HIV, and is recommended in an HIV care program in Gauteng province, its implementation there is low, the study authors noted. Based on in-depth interviews and a focus group discussion, they described barriers to IPT implementation in the donor-funded program as well as provider and patient perspectives on IPT.

The team interviewed 22 clinic staff and 20 patients from 10 purposively selected HIV clinics in the program. Staff members were surveyed about their knowledge of and experience with IPT and about barriers to its implementation. Patients were asked their opinions about IPT.

The primary barriers to IPT were lack of knowledge and experience, staff reported. Prescribers were unaware of IPT benefits and unclear about guidelines. Other barriers included the belief that TB screening tools are inaccurate in HIV patients and the need to refer patients to separate clinics to conduct TB screenings. None of the patients had ever heard of IPT.

"Barriers to the widespread use of IPT primarily derived from health care workers, in particular lack of experience among physicians," the authors concluded. "In addition to overcoming operational barriers, a change in health care worker perception is needed if IPT is to be widely used; we suggest local clinical opinion leaders could help achieve this."