Integrating Isoniazid Preventive Therapy into the Fast-Track HIV Treatment Model in Urban Zambia: A Proof-of -Concept Pilot Project

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Abstract Introduction Most people living with HIV (PLHIV) who are established on treatment in Zambia receive multi-month prescribing and dispensing (MMSD) of antiretroviral therapy (ART) and are enrolled in less-intensive differentiated service delivery (DSD) models, such as Fast Track (FT), in which clients pick up ART every 3-6 months and make clinical visits to health facilities every 6 months. In 2019, Zambia introduced Isoniazid Preventive Therapy (IPT) with scheduled visits at 2 weeks and 1, 3, and 6 months. The asynchronous IPT and HIV appointment schedules were inconvenient and not client centered. In response, we piloted integrated MMSD/IPT in the FT HIV treatment model. Methods We implemented and evaluated a proof-of-concept pilot project at one purposively selected high-volume facility in Lusaka, Zambia between July 2019 and May 2020. We sensitized stakeholders, adapted training materials and standard operating procedures, and screened adults in FT for TB as per national guidelines. Participants received structured TB/IPT education, a 6-month supply of isoniazid and ART, an aligned 6 th month IPT/MMSD clinic appointment, and phone appointments at 2 weeks and months 1-5 following IPT initiation. We used descriptive statistics to characterize IPT completion rates, phone appointment keeping, side effect frequency and Fisher’s exact test to determine if these varied by participant characteristics. Notes from monthly meetings and discussions were used to synthesize key lessons learned. Results 1,167 clients were screened for eligibility and 818 (70.1%) were enrolled. Two thirds (66%) were female, median age was 42 years, and 56.6% had been on ART for ≥ 5 years. 738 (90.2%) completed a 6-month course of IPT and 66 (8.1%) reported IPT-related side effects. 539 clients (65.9%) attended all 7 telephone appointments. There were no significant differences in these outcomes by age, sex, or time on ART. Lessons learnt include the value of promoting project ownership, client empowerment, securing supply chain, adapting existing processes, and cultivating a collaborative structured learning environment. Conclusions Integrating multi-month dispensing and telephone follow up of IPT into the FT HIV treatment model is a promising approach to scaling-up TB preventive treatment among PLHIV, although limited by barriers to consistent phone access.

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