Biomarker-confirmed suboptimal adherence to isoniazid preventive therapy among children with HIV in western Kenya

Dickens Otieno Onyango, MAB van der Sande, CM Yuen, Joyce A. Were, J Mecha, LN Njagi, N Panpradist, D Matemo, D Leon, B Lutz, J Kinuthia, G John-Stewart, SM Lacourse

Research output: Contribution to journalA1: Web of Science-articlepeer-review


The aim of this study was to assess the level and correlates of biomarker-confirmed adherence to isoniazid (INH) preventive therapy (IPT) among children with HIV (CLHIV).

This prospective cohort study assessed adherence among CLHIV on IPT in public sector HIV clinics from 2019 through 2020.

Adherence was assessed by pill counts or caregiver or self-reports, and urine biomarkers (in-house dipstick and Isoscreen). Both urine biomarker tests detect INH metabolites within 48 h of ingestion. Consistent adherence was defined as having positive results on either biomarker at all visits. Correlates of biomarker-confirmed nonadherence at each visit were evaluated using generalized estimating equations. The in-house dipstick was validated using Isoscreen as the reference.

Among 97 CLHIV on IPT with adherence assessments, median age was 10 years (IQR 7–13). All were on ART at IPT initiation (median duration 46 months [IQR 4–89]); 81% were virally suppressed (<1000 copies/ml). At all visits, 59% (n = 57) of CLHIV reported taking at least 80% of their doses, while 39% (n = 38) had biomarker-confirmed adherence. Viral nonsuppression (adjusted risk ratio [aRR] = 1.65; 95% confidence interval [95% CI] 1.09–2.49) and the sixth month of IPT use (aRR = 2.49; 95% CI 1.34–4.65) were independent correlates of biomarker-confirmed nonadherence at each visit. Sensitivity and specificity of the in-house dipstick were 98.1% (94.7–99.6%) and 94.7% (88.1–98.3%), respectively, versus Isoscreen.

Biomarker-confirmed adherence to IPT was sub-optimal and was associated with viral nonsuppression and duration of IPT. Urine dipstick testing may be useful in assessing adherence to IPT in clinical care.
Original languageEnglish
Issue number1
Pages (from-to)39-47
Number of pages9
Publication statusPublished - 2024


  • Mycobacterium tuberculosis infection
  • Children with HIV
  • Isoniazid preventive therapy
  • Medication adherence
  • Tuberculosis
  • Urine biomarkers


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