As the focus for TB control by most public health experts and clinicians in high burden areas is to find active TB cases for prompt care and therapy, the findings in this study for provision of IPT for eligible TB free PLHIV was 32.0%, this means there were considerable missed opportunities. In addition, comparable proportion of interviewed study subjects reported to know (~30%) about the availability of IPT in the respective health facilities. The low coverage of IPT was due to lack of consistency among health care providers towards providing IPT, shortage of Isoniazid and inequitable availability of investigation setups (X-ray, Fine Needle Aspirations, etc.) at the different health facilities to apparently rule out active TB.
Study participants who completed secondary and post secondary education were found to be better informed about the availability of IPT more than those who were not formally educated. These findings may suggest that educated people are more concerned about their disease patterns and seek additional information better than those of less educated. This might be due to better access to printed media than the less educated counterparts beyond other source of information. This finding was also similar with findings in other countries (China, Malawi and Zambia) [11
In addition, length of being diagnosed for HIV positive and being informed about IPT had a significant association. Those who knew their HIV positive status for more than six months were about two times more likely to be informed about availability of IPT as a package of HIV care than those who were less than six months. This showed that as people stay longer learning about their HIV status, they become more and more aware of their health conditions and opportunistic infections.
In this study females were more informed about the availability of IPT in their health facilities as a package of HIV care for PLHIV than males. This is in contrary to most findings; a study in rural Vietnamese showed males were two times more informed than the females [12
]. Our result was also in contrary to a previous finding where higher proportion of males (87%) had some kind of educational attainment than females (75%) indicating better access to printed media in Addis Ababa [13
]. However, it is very difficult to make a strong conclusion as the study participants self-select health facilities or it maybe due to men going to private facilities as they are better off in economic status than women.
IPT is one of the key interventions recommended by WHO in 1998 to reduce the burden of TB in PLHIV; yet implementation of IPT had been very low in different countries [14
]. The proportion of PLHIV who were free from TB but provided with IPT was only 32.0%. This illustrated the missed opportunities in the prevention of TB in high burden countries such as Ethiopia. However, the proportion of PLHIV in Ethiopia receiving IPT is considerably higher than in most other countries. Globally, only 27,000 PLHIV without active TB were started on IPT (0.1% of the 33 million people estimated to be infected with HIV), almost all of whom were in Botswana [15
]. In another study in Italy, for example; the number of people actually starting IPT was very low. This was because of the small number who had a positive TST, contraindications to isoniazid and refusal of the eligible to the offered IPT [16
Generally, provision of IPT among PLHIV in developing countries is linked to operational problems and Ethiopia is not exceptional. There is no system of doing the TST due to lack of national protocol for provision of IPT for eligible PLHIV, lack of trained personnel who do the TST, lack of supply of the test as well as problems related to administration of the TST and follow up.
This study is limited to primary data sources and lacks supportive evidence from secondary data on the TB/HIV collaborative activities. Interviewer and/or observation bias might not be avoided as all the data collectors were health professionals.