1. High Adherence to Isoniazid for Tuberculosis Preventive Therapy among HIV-infected Persons in Chiang Rai, Thailand (Abstract 470) Jintana Ngamvithayapong-Yanai 1,2 Sarmwai Luangjina 1 Hideki Yanai 2 Pathom Sawanpanyalert 3 1 TB/HIV Research Foundation, Thailand, 2 The Research Institute of Tuberculosis, JATA, Japan, 3 Ministry of Public Health, Thailand Supported by Japanese Foundation for AIDS Prevention (JFAP) and Ministry of Health, Welfare and Labor, Japan

2. Abbreviations FGD = Focus group discussion INH = Isoniazid IPT = Isoniazid Preventive Therapy for Tuberculosis PWH = People with HIV infection (asymptomatic stage) Objective To investigate the reasons for a high level of adherence to the nine-month IPT

3. Regimen Daily 300 mg. Of INH and vitamin B complex for 9 months (one month supply) Clients and setting PWH (recruited from blood donors, outpatients clinic, anonymous HIV testing clinics and sex workers) Chiang Rai Regional Hospital Definition “High level of adherence” = clients who took 95-100% of INH of the total number of prescribed INH pills in 9 months

4. Methods of assessing adherence to IPT 1. Quantitative assessment -To know the level of adherence 2. Qualitative assessment - To know the reasons why a group of PWH could achieve a high level of adherence although they were in “asymtomatic stage of HIV infection” and AIDS stigma is a problem in the study setting. This paper discuss about qualitative assessment of adherence to IPT with special emphasis on “high level of adherence”

5. Methods of assessing adherence to IPT 1. Measuring the level of adherence pill counting Adherence % = no.of prescribed INH taken by the client X 100 no.of INH prescribed for the client patient self-report measure of appointment kept 2. Assessing reasons for high level of adherence FGD with the clients who achieved a high level of adherence.

6. Method: Selection of FGD participants PHA participated in the IPT program = 412 PHA achieved a high level of adherence = 42 PHA participated in the FGD = 28 1 group of single males 2 groups of married males 1 group of married females 1 group of widowed females Grouping based on homogeneous attributes

7. Strength and limitation of FGD Limitation: Some participants did not want to open themselves to other members of the groups due to HIV/AIDS stigma. Therefore, reasons and methods for achieving a high level of adherence to IPT of these participants are not known

8. Strength and limitation of FGD Strength: The five sessions of FGD were conducted by the same moderator -- increase validity of the data Interactions among the participants generated rich information which can not be obtained by individual interview Provided rich information from a group of people quickly with less cost

9. Recommendations The paper highlights two methodological aspects of research on adherence: 1. Assessing reasons for “good adherence” rather than “non-adherence” which many studies have done. The results are applicable to improve adherence in other settings 2. FGD is a promising tool for qualitative assessment of adherence to treatment

10. Acknowledgement Japanese Foundation for AIDS Prevention (JFAP) and Ministry of Health, Welfare and Labor, Japan supported the study Dr.Renu Srismith, Dr.Wat Uthaivoravit and staff nurses of Social Preventive Medicine Department, Chiang Rai Hospital for approval the study and their kind collaboration. All participants kindly participated in the focus group discussion