Adherence, tolerability, and outcome after 36 months of isoniazid-preventive therapy in 2 rural clinics of Swaziland

Müeller, Yolanda; Mpala, Qhubekani; Kerschberger, Bernhard; Rusch, Barbara; Mchunu, Gugu; Mazibuko, Sikhathele; Bonnet, Maryline

doi:10.1097/md.0000000000007740

Cited by 11 publications

(15 citation statements)

References 18 publications

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“…Other studies have shown that the following subpopulations have an increased risk of TB incidence: prisoners (46), migrants (47), health care workers (48), miners (4), and contacts of indexed TB cases (49). Other studies have found that other protective factors against TB incidence include the use of IPT (13, 50), cash transfers (51), as well as early TB detection and treatment initiation (52).…”

Section: Discussionmentioning

confidence: 99%

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

Mollel

Maokola

Todd

et al. 2019

Front. Public Health

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Background: HIV and tuberculosis (TB) are leading infectious diseases, with a high risk of co-infection. The risk of TB in people living with HIV (PLHIV) is high soon after sero-conversion and increases as the CD4 counts are depleted.Methodology: We used routinely collected data from Care and Treatment Clinics (CTCs) in three regions in northern Tanzania. All PLHIV attending CTCs between January 2012 to December 2017 were included in the analysis. TB incidence was defined as cases started on anti-TB medications divided by the person-years of follow-up. Poisson regression with frailty models were used to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for predictors of TB incidences among HIV positive patients.Results: Among 78,748 PLHIV, 405 patients developed TB over 195,296 person-years of follow-up, giving an overall TB incidence rate of 2.08 per 1,000 person-years. There was an increased risk of TB incidence, 3.35 per 1,000 person-years, in hospitals compared to lower level health facilities. Compared to CD4 counts of <350 cells/μl, a high CD4 count was associated with lower TB incidence, 81% lower for a CD4 count of 350–500 cells/μl (IRR 0.19, 95% CI 0.04–0.08) and 85% lower for those with a CD4 count above 500 cells/μl (IRR 0.15, 95% CI 0.04–0.64). Independently, those taking ART had 66% lower TB incidences (IRR 0.34, 95% CI 0.15–0.79) compared to those not taking ART. Poor nutritional status and CTC enrollment between 2008 and 2012 were associated with higher TB incidences IRR 9.27 (95% CI 2.15–39.95) and IRR 2.97 (95% CI 1.05–8.43), respectively.Discussion: There has been a decline in TB incidence since 2012, with exception of the year 2017 whereby there was higher TB incidence probably due to better diagnosis of TB following a national initiative. Among HIV positive patients attending CTCs, poor nutritional status, low CD4 counts and not taking ART treatment were associated with higher TB incidence, highlighting the need to get PLHIV on treatment early, and the need for close monitoring of CD4 counts. Data from routinely collected and available health services can be used to provide evidence of the epidemiological risk of TB.

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Section: Discussionmentioning

confidence: 99%

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

Mollel

Maokola

Todd

et al. 2019

Front. Public Health

View full text Add to dashboard Cite

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“…Among cohorts that did not receive LTBI tests, the cumulative TPT initiation and completion were similar if PLHIV were followed at HIV clinics or other clinics (S5 Fig [18,21,24,38,51,58,66,[70][71][72][73][74][75][76]78,79,82]. The most common facilitators were related to the initial steps (identification, initial LTBI testing, and completing LTBI testing) and to initiation and completion of TPT.…”

Section: Plos Medicinementioning

confidence: 96%

“…Pill burden, fear of adverse events, and stocks out of LTBI drugs were also reported as barriers for starting and completing TPT [18,34,72,74,78]. [18,38,72,74,76,79,82] • Fragmentation of care of HIV and TB patients [34,81] • Testing and TPT were implemented by TB programs that were not familiar with the care of HIV patients [66] • Stigma of HIV patients receiving care in TB clinics [72,74] • Lack of information, motivation, and support to HCW [21,80,81] • Too much workload [81] Identification • Participation of staff in the design of TPT implementations strategy [70] • Patient education material [70] • HIV testing for household contacts of infectious TB disease [38,71] • Community HCWs initiating contact [71] • TB/HIV care in antenatal care services [73,75] • Creation of a TB/HIV integration officer and a TB screening officer [76] • Task shifting TB screening to primary care [76] • None Identified Initial testing • Theoretical training on TST [18,24] • TST training [18,24,70] • Extra consultation room [18] • TB screening by "lay counselor" [18] • TB screening done by physicians [24] • TB nurse dedicated for administration of TST [24] • TB counseling at the moment of HIV diagnosis…”

Section: Plos Medicinementioning

confidence: 99%

The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

et al. 2021

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Background Tuberculosis preventive therapy (TPT) reduces TB-related morbidity and mortality in people living with HIV (PLHIV). Cascade-of-care analyses help identify gaps and barriers in care and develop targeted solutions. A previous latent tuberculosis infection (LTBI) cascade-of-care analysis showed only 18% of persons in at-risk populations complete TPT, but a similar analysis for TPT among PLHIV has not been completed. We conducted a meta-analysis to provide this evidence. Methods and findings We first screened potential articles from a LTBI cascade-of-care systematic review published in 2016. From this study, we included cohorts that reported a minimum of 25 PLHIV. To identify new cohorts, we used a similar search strategy restricted to PLHIV. The search was conducted in Medline, Embase, Health Star, and LILACS, from January 2014 to February 2021. Two authors independently screened titles and full text and assessed risk of bias using the Newcastle–Ottawa Scale for cohorts and Cochrane Risk of Bias for cluster randomized trials. We meta-analyzed the proportion of PLHIV completing each step of the LTBI cascade-of-care and estimated the cumulative proportion retained. These results were stratified based on cascades-of-care that used or did not use LTBI testing to determine eligibility for TPT. We also performed a narrative synthesis of enablers and barriers of the cascade-of-care identified at different steps of the cascade. A total of 71 cohorts were included, and 70 were meta-analyzed, comprising 94,011 PLHIV. Among the PLHIV included, 35.3% (33,139/94,011) were from the Americas and 29.2% (27,460/94,011) from Africa. Overall, 49.9% (46,903/94,011) from low- and middle-income countries, median age was 38.0 [interquartile range (IQR) 34.0;43.6], and 65.9% (46,328/70,297) were men, 43.6% (29,629/67,947) were treated with antiretroviral therapy (ART), and the median CD4 count was 390 cell/mm3 (IQR 312;458). Among the cohorts that did not use LTBI tests, the cumulative proportion of PLHIV starting and completing TPT were 40.9% (95% CI: 39.3% to 42.7%) and 33.2% (95% CI: 31.6% to 34.9%). Among cohorts that used LTBI tests, the cumulative proportions of PLHIV starting and completing TPT were 60.4% (95% CI: 58.1% to 62.6%) and 41.9% (95% CI:39.6% to 44.2%), respectively. Completion of TPT was not significantly different in high- compared to low- and middle-income countries. Regardless of LTBI test use, substantial losses in the cascade-of-care occurred before treatment initiation. The integration of HIV and TB care was considered an enabler of the cascade-of-care in multiple cohorts. Key limitations of this systematic review are the observational nature of the included studies, potential selection bias in the population selection, only 14 cohorts reported all steps of the cascade-of-care, and barriers/facilitators were not systematically reported in all cohorts. Conclusions Although substantial losses were seen in multiple stages of the cascade-of-care, the cumulative proportion of PLHIV completing TPT was higher than previously reported among other at-risk populations. The use of LTBI testing in PLHIV in low- and middle-income countries was associated with higher proportion of the cohorts initiating TPT and with similar rates of completion of TPT.

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“…Few studies have reported programmatic experience with the longer regimen recommended for countries with high TB prevalence [ 29 ]. One encouraging report from Eswatini showed that 36 months of IPT was feasible and had favorable outcomes among tuberculin skin test-positive PLHIV in two clinics [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Early-phase scale-up of isoniazid preventive therapy for people living with HIV in two districts in Malawi (2017)

et al. 2021

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Background Isoniazid preventive therapy (IPT) against tuberculosis (TB) is a life-saving intervention for people living with HIV (PLHIV). In September 2017, Malawi began programmatic scale-up of IPT to eligible PLHIV in five districts with high HIV and TB burden. We measured the frequency and timeliness of early-phase IPT implementation to inform quality-improvement processes. Methods and findings We applied a two-stage cluster design with systematic, probability-proportional-to-size sampling of six U.S. Centers for Disease Control and Prevention (CDC)-affiliated antiretroviral therapy (ART) centers operating in the urban areas of Lilongwe and Blantyre, Malawi (November 2017). ART clinic patient volume determined cluster size. Within each cluster, we sequentially sampled approximately 50 PLHIV newly enrolled in ART care. We described a quality-of-care cascade for intensive TB case finding (ICF) and IPT in PLHIV. PLHIV newly enrolled in ART care were eligibility-screened for hepatitis and peripheral neuropathy, as well as for TB disease using a standardized four-symptom screening tool. Among eligible PLHIV, the overall weighted IPT initiation rate was 70% (95% CI: 46%–86%). Weighted IPT initiation among persons aged <15 years (30% [95% CI: 12%–55%]) was significantly lower than among persons aged ≥15 years (72% [95% CI: 47%–89%]; Rao-Scott chi-square P = 0.03). HIV-positive children aged <5 years had a weighted initiation rate of only 13% (95% CI: 1%–79%). For pregnant women, the weighted initiation rate was 67% (95% CI: 32%–90%), similar to non-pregnant women aged ≥15 years (72% [95% CI: 49%–87%]). Lastly, 95% (95% CI: 92%–97%) of eligible PLHIV started ART within one week of HIV diagnosis, and 92% (95% CI: 73%–98%) of patients receiving IPT began on the same day as ART. Conclusions Early-phase IPT uptake among adults at ART centers in Malawi was high. Child uptake needed improvement. National programs could adapt this framework to evaluate their ICF-IPT care cascades.

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Adherence, tolerability, and outcome after 36 months of isoniazid-preventive therapy in 2 rural clinics of Swaziland

Cited by 11 publications

References 18 publications

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

Early-phase scale-up of isoniazid preventive therapy for people living with HIV in two districts in Malawi (2017)

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