Assessment of Contextual Factors Shaping Delivery and Uptake of Isoniazid Preventive Therapy Among People Living with HIV in Dar Es Salaam, Tanzania.

Abstract Background Tuberculosis has remained a leading cause of deaths among People Living with HIV (PLHIV) globally. Isoniazid Preventive Therapy is the recommended strategy by the WHO to prevent TB disease and related deaths among PLHIV. However, delivery and uptake of IPT has remained suboptimal particularly in countries where HIV and TB are endemic such as Tanzania. The study sought to assess contextual factors that shape delivery of IPT in Dar Es Salaam region, Tanzania. MethodologyA qualitative case study design was utilized whereby, in-depth interviews (n=26 ) of clinicians and people living with HIV and Key Informat Interviews (n=7) involving health administrators, were conducted. Thematic data analysis was done and reporting was guided by Consolidated Framework for Implementation Research (CFIR). Results Characteristics of intervention such as its adaptability to local contexts and relatively low cost of implementation facilitated its implementation. IPT was outsourced but this did not affect its implementation. On the contrary adverse effects of isoniazid that negatively affected implementation. Characteristics of individuals implementing the intervention including good knowledge and attitude towards IPT, commitment and efficacy of execution facilitated implementation. The process of IPT delivery that was characterized by engagement of stakeholders and implementors in planning facilitated implementation. Inner settings characteristics like connectedness among units, availability of resources and good implementation climate favoured implementation. Factors external to the implementing facilities such as networking of, and competitive pressure among facilities influenced delivery and uptake of IPT while HIV related stigma and some religious values stood as barriers.ConclusionAddressing policy related, procedural and individual barriers of IPT implementation at all levels of implementation is critical to effective implementation of this important intervention and ensuring all eligible people living with HIV are covered by IPT.