Health workers’ knowledge and practice of Isoniazid preventive treatment guidelines in health facilities in Ebonyi State, Nigeria

Ifeyinwa Chizoba Akamike^1,2, Ijeoma Nkem Okedo-Alex^1,2, Chigozie Jesse Uneke², Ugochukwu Chinyem Madubueze^1,3, Urudinachi Nnenne Agbo^1,2, Ifeyinwa Maureen Okeke^1,2, Lawrence Ulu Ogbonnaya^1,2,3

1. Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria
2. African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
3. Alex Ekwueme Federal University, Ndufu Alike Ikwo, Ebonyi State, Nigeria
   *Corresponding Author: Ifeyinwa Chizoba Akamike; E-mail: ifeyakamike@gmail.com

Abstract
Background
Isoniazid preventive therapy is recommended as part of a comprehensive HIV and AIDS care strategy. IPT is used as prophylaxis to reduce the incidence of TB in HIV-infected persons. However, its implementation has been very slow and has been influenced by several factors. This study assessed health workers’ knowledge and adherence to Isoniazid Preventive Therapy guidelines.
Methods
This was a cross-sectional study in six health facilities providing HIV care in Ebonyi State using a semi-structured, self-administered questionnaire. Data were collected from 85 health workers working in the HIV clinics. Data were also extracted from 200 patient treatment cards. Data analysis was carried out using SPSS version 20 software. Chi-square statistics and logistic regression were carried out to determine the association between socio-demographic characteristics and knowledge as well as self-reported practice of the guideline.
Result
Slightly over half of the respondents (58.8%) had good knowledge of the guideline, and the majority (75.3%) self-reported that they practiced the guideline. Only 17% of the treatment cards had isoniazid prescribed and only 11% of these had patient adherence assessed. The most common challenges to implementation of the guideline cited by health workers were unavailability of isoniazid, poor awareness, patient non-adherence, poor resources, high pill burden, and lack of training. Being a doctor and more than 3 years duration of work in the clinic were predictors of good knowledge. There was no predictor of practice.
Conclusion
There was good knowledge and practice of the guideline from health worker self-reports, however, review of treatment card showed prescription was low. Further studies to explore and understand why there is such low prescription of INH/IPT to HIV patients despite good knowledge of healthcare professionals are recommended.

Key Words: Tuberculosis prevention; Health provider; Implementation; Guideline; Nigeria