Objective: To systematically identify from qualitative data in the published literature the main barriers to adherence to
isoniazid preventive therapy (IPT) for tuberculosis (TB) among people living with HIV/AIDS (PLWHA).
Methods: We searched ten data sources, including MEDLINE and EMBASE for articles published in peer-reviewed journals
from inception through to December 2011 for evidence relevant to IPT for TB in relation to PLWHA. Studies were assessed
for quality using the CASP critical appraisal tool for qualitative studies. Data extracted from studies were then analysed
thematically using thematic synthesis.
Results: Eight studies, two of which were conducted within the same clinical trial, met the inclusion criteria. In addition to
the influence of personal characteristics, five overarching themes were identified: Individual personal beliefs; HIV treatment
and related issues; Socio-economic factors; Family and other social support factors, and Relationships with health providers.
The review confirms current understanding of adherence to treatment as influenced by patients’ understanding of, and
beliefs related to treatment regimens. This is in-turn influenced by broader factors, namely: socio-economic factors such as
poverty and lack of health facilities; the level of support available to patients from family and other networks and the stigma
that emanates from these relationships; and relationships with health providers, which in-turn become a delicate issue
given the sensitivity of dealing with two chronic diseases of significant morbidity and mortality toll. HIV treatment related
issues also influence adherence to IPT, whereby challenges related to the acceptance, organisation and administration of
these two long-term treatment regimens and stigma related to HIV/AIDS, are seen to be major factors.
Conclusion: Understanding this complex interplay of factors more clearly is essential for healthcare decision-makers to be
able to achieve the level of adherence required to effectively mitigate the threat posed by co-infection with TB and HIV/
AIDS in developing countries.