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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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Infectious diseases
Research
Factors affecting the acceptability of isoniazid preventive therapy among healthcare providers in selected HIV clinics in Nairobi County, Kenya: a qualitative study
  1. Elvis Omondi Achach Wambiya1,2,
  2. Martin Atela3,4,
  3. Ejemai Eboreime2,5,
  4. Latifat Ibisomi2,6
  1. 1 Research unit, African Population and Health Research Center, Nairobi, Kenya
  2. 2 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  3. 3 Research Uptake & Policy Engagement Unit, Partnership for African Social & Governance Research, Nairobi, Kenya
  4. 4 Public Health department, College of Health Sciences, University of Nairobi, Nairobi, Kenya
  5. 5 Department of Planning Research & Statistics, National Primary Health Care Development Agency, Abuja, Nigeria
  6. 6 Research unit, Nigerian Institute of Medical Research (NIMR), Lagos, Nigeria
  1. Correspondence to Mr Elvis Omondi Achach Wambiya; eowambiya{at}gmail.com

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.

  • HIV & AIDS
  • tuberculosis
  • qualitative research
  • public health

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/.

https://doi.org/10.1136/bmjopen-2018-024286

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors EOAW, MA and LI contributed to the conceptualisation and design of the study including the development of the study tools. EOAW collected the data and did initial analysis and drafts of the manuscript. EE, MA and LI contributed to the data analysis, manuscript writing and editing. All authors read and approved the final version of the manuscript.

    • Funding This work was funded by TDR, the Special Programme for Research and Training in Tropical Diseases, which is hosted at WHO and cosponsored by UNICEF, UNDP, the World Bank and WHO. TDR grant number: B40299. First author ORCID ID: 0000-0002-4149-3417.

    • Competing interests None declared.

    • Ethics approval Study approval and ethical clearance was obtained from the University of the Witwatersrand Human Research Ethics Committee (HREC) (approval No. M161164), Kenyatta National Hospital—University of Nairobi Ethics and Research Committee (approval No. P11/01/2017) and the Kenya Medical Research Institute Ethics and Research Committee (approval No. RES/7/3/1).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.