Barriers to implementation of isoniazid preventive therapy in HIV clinics: a qualitative study

Lester, Rebecca; Hamilton, Robin; Charalambous, Salome; T, Dwadwa; Chandler, Clare I R; Churchyard, Gavin J.; Grant, Alison D.

doi:10.1097/01.aids.0000391021.18284.12

Cited by 85 publications

(184 citation statements)

References 6 publications

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“…Meta-analyses of randomized controlled trials have shown that IPT reduces the risk of active TB by 33% in people living with HIV, irrespective of skin test result, and by up to 64% in those with a positive tuberculin skin test [20,21]. Despite the substantial amount of clinical research that showed the benefits of IPT among people living with HIV, several barriers and operational challenges have hampered its roll out [22].…”

Section: Key Areas Of Operational Researchmentioning

confidence: 99%

Improving the prevention, diagnosis and treatment of TB among people living with HIV: the role of operational research

Sculier

Getahun

Lienhardt

2011

Journal of the International AIDS Society

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Operational research is necessary to improve the access to and delivery of tuberculosis prevention, diagnosis and treatment interventions for people living with HIV. We conducted an extensive review of the literature and reports from recent expert consultations and research-related meetings organized by the World Health Organization and the Stop TB Partnership to identify a TB/HIV operational research agenda. We present critical operational research questions in a series of key areas: optimizing TB prevention by enhancing the uptake of isoniazid preventive therapy and the implementation of infection control measures; assessing the effectiveness of existing diagnostic tools and scaling up new technologies; improving service delivery models; and reducing risk factors for mortality among TB patients living with HIV. We discuss the potential impact that addressing the operational research questions may have on improving programmes’ performance, assessing new strategies or interventions for TB control, or informing global or national policy formulation. Financial resources to implement these operational research questions should be mobilized from existing and new funding mechanisms. National TB and HIV/AIDS programmes should develop their operational research agendas based on these questions, and conduct the research that they consider crucial for improving TB and HIV control in their settings in collaboration with research stakeholders.

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Section: Key Areas Of Operational Researchmentioning

confidence: 99%

Improving the prevention, diagnosis and treatment of TB among people living with HIV: the role of operational research

Sculier

Getahun

Lienhardt

2011

Journal of the International AIDS Society

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“…In Ivory Coast, the national guidelines do not recommend the use of IPT, owing to the concern that IPT may select resistant bacilli when given to patients with undiagnosed tuberculosis. 19,20 The Ministry of Health accepted its use within an experimental framework.…”

mentioning

confidence: 99%

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

2015

N Engl J Med

1,021

447

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BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

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“…Of the 2,305 TSTs performed, 1,053 (46%) were performed in indigenous populations; 831 (36%) were screenings in prisons, performed for training; and only 421 (18%) involved contacts of tuberculosis patients or priority populations, such as HIV-infected individuals. (16) In the indigenous populations, the TSTs resulted in 124 patients being treated for latent tuberculosis, a figure that is noteworthy Our analysis of TST use reveals a disconnect between guidelines and practice. Although scientific evidence of the importance of the TST and preventive treatment for latent tuberculosis has been collected for 18 years, this does not seem to be reflected in the number of TSTs performed in the various at-risk populations, in which the test should be administered on an annual basis, or in the number of individuals treated for latent tuberculosis.…”

Section: Discussionmentioning

confidence: 84%

“…Our survey revealed that there were no training courses for the health care workers at the specialized PCCs under study; among those observed for all of the priority municipalities that had TCPs and specialized PCCs. (16) Five screenings were performed in prisons, and one was performed at a military barracks. Those screenings were performed either in an attempt to identify contacts of tuberculosis patients or in order to provide technical training.…”

Section: Resultsmentioning

confidence: 99%

Teste tuberculínico: pesquisa operacional no Mato Grosso do Sul

et al. 2011

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Objective: To investigate operational aspects of tuberculin skin test (TST) use in tuberculosis control programs and at specialized Brazilian National Sexually Transmitted Diseases/AIDS and Viral Hepatitis Program health care clinics in priority municipalities for tuberculosis control in the state of Mato Grosso do Sul, Brazil. Methods: This was a descriptive, cross-sectional, epidemiological survey. Data on qualifications/training of professionals administering TSTs, timing of the TST, procedures in cases of loss to follow-up (reading), material availability, and material storage were collected through interviews and technical visits. For the 2008-2009 period, we determined the numbers of screenings in vulnerable populations, of TSTs performed, and of patients treated for latent tuberculosis. Results: We interviewed 12 program managers in six municipalities. Some programs/clinics did not perform TSTs. Nursing teams administered the TSTs, results were read by non-specialists, and specialization/refresher courses were scarce. The PPD RT23 was stored in 5-mL flasks under appropriate conditions. Insulin syringes were commonly used. Testing was available during business hours, three times a week. In cases of loss to follow-up, telephone calls or home visits were made. Of the 2,305 TSTs evaluated, 1,053 (46%) were performed in indigenous populations; 831 (36%) were screenings in prisons, performed for training; and only 421 (18%) involved contacts of tuberculosis patients or vulnerable populations. Four vulnerable patients and 126 indigenous subjects were treated for latent tuberculosis. Conclusions: These priority municipalities showed operational difficulties regarding human resources, materials, and data records. ResumoObjetivo: Investigar a operacionalização da utilização do teste tuberculínico (TT) em programas de controle de tuberculose e em serviços de assistência especializada do Programa Nacional de Doenças Sexualmente Transmissíveis/AIDS e Hepatites Virais em municípios prioritários para o controle da tuberculose no estado de Mato Grosso do Sul. Métodos: Estudo epidemiológico descritivo, transversal, do tipo inquérito. A formação profissional dos responsáveis pela realização do TT, existência de treinamentos, período de realização dos TTs, conduta em caso de perda de leitura, insumos disponíveis e sua conservação foram levantados por meio de entrevistas e visitas técnicas. O número de inquéritos em populações vulneráveis, número de TTs realizados e número de pacientes em tratamento de tuberculose latente entre 2008 e 2009 foram também levantados. Resultados: Foram entrevistados 12 gestores de seis municípios. Alguns programas/serviços não realizavam o TT. A equipe de enfermagem realizava os TTs, não havia leitores especialistas, e treinamentos eram raros. A conservação dos frascos de PPD RT23 (5 mL) era adequada. Frequentemente utilizava-se a seringa de insulina. A realização de TT ocorria no horário comercial, três vezes na semana. Em caso de perda de leitura em alguns locais, realizava-se contato...

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Barriers to implementation of isoniazid preventive therapy in HIV clinics: a qualitative study

Cited by 85 publications

References 6 publications

Improving the prevention, diagnosis and treatment of TB among people living with HIV: the role of operational research

Improving the prevention, diagnosis and treatment of TB among people living with HIV: the role of operational research

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

Teste tuberculínico: pesquisa operacional no Mato Grosso do Sul

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