Completion of isoniazid preventive therapy and survival in HIV-infected, TST-positive adults in Tanzania

Kabali, Conrad; Reyn, C. Fordham von; Brooks, Daniel R.; Waddell, Richard; Mtei, Lillian; Bakari, Mohamed; Matee, Mecky; Pallangyo, Kisali; Rd, Arbeit; Horsburgh, C. Robert

doi:10.5588/ijtld.10.0788

Cited by 32 publications

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“…Similar assessments were done in Brazil and South Africa and comparable results were documented in the effectiveness of IPT with ART while IPT coverage (10 and 13% respectively) and effectiveness of ‘IPT only’ (43 and 13% respectively) were much lower than the findings from our study [5], [6]. In a different study in Tanzania, IPT was not found to be effective at all [20]. Our study presents new evidence on the effect of timing of IPT initiation with respect to ART.…”

Section: Discussionsupporting

confidence: 86%

Beneficial Effect of Isoniazid Preventive Therapy and Antiretroviral Therapy on the Incidence of Tuberculosis in People Living with HIV in Ethiopia

et al. 2014

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BackgroundIPT with or without concomitant administration of ART is a proven intervention to prevent tuberculosis among PLHIV. However, there are few data on the routine implementation of this intervention and its effectiveness in settings with limited resources.ObjectivesTo measure the level of uptake and effectiveness of IPT in reducing tuberculosis incidence in a cohort of PLHIV enrolled into HIV care between 2007 and 2010 in five hospitals in southern Ethiopia.MethodsA retrospective cohort analysis of electronic patient database was done. The independent effects of no intervention, “IPT-only,” “IPT-before-ART,” “IPT-and-ART started simultaneously,” “ART-only,” and “IPT-after-ART” on TB incidence were measured. Cox-proportional hazards regression was used to assess association of treatment categories with TB incidence.ResultsOf 7,097 patients, 867 were excluded because they were transferred-in; a further 823 (12%) were excluded from the study because they were either identified to have TB through screening (292 patients) or were on TB treatment (531). Among the remaining 5,407 patients observed, IPT had been initiated for 39% of eligible patients. Children, male sex, advanced disease, and those in Pre-ART were less likely to be initiated on IPT. The overall TB incidence was 2.6 per 100 person-years. As compared to those with no intervention, use of “IPT-only” (aHR = 0.36, 95% CI = 0.19–0.66) and “ART-only” (aHR = 0.32, 95% CI = 0.24–0.43) were associated with significant reduction in TB incidence rate. Combining ART and IPT had a more profound effect. Starting IPT-before-ART (aHR = 0.18, 95% CI = 0.08–0.42) or simultaneously with ART (aHR = 0.20, 95% CI = 0.10–0.42) provided further reduction of TB at ∼80%.ConclusionsIPT was found to be effective in reducing TB incidence, independently and with concomitant ART, under programme conditions in resource-limited settings. The level of IPT provision and effectiveness in reducing TB was encouraging in the study setting. Scaling up and strengthening IPT service in addition to ART can have beneficial effect in reducing TB burden among PLHIV in settings with high TB/HIV burden.

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Section: Discussionsupporting

confidence: 86%

Beneficial Effect of Isoniazid Preventive Therapy and Antiretroviral Therapy on the Incidence of Tuberculosis in People Living with HIV in Ethiopia

et al. 2014

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“…Although not universally detected, several studies have shown improved survival among IPT recipients: completion of 6IPTwas associated with a 60% reduction in mortality in a Tanzanian cohort of TST-positive HIV-infected participants with baseline CD4 + cell count at least 200 cells/μl and with access to ART [20]; a retrospective analysis of South African miners initiating ART showed that 6IPT reduced their risk of death by 66% [21]. The Soweto IPT trial observed the lowest rate of ‘death or TB’ in TST-positive HIV-infected participants receiving 36IPT [15].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis incidence after 36 months’ isoniazid prophylaxis in HIV-infected adults in Botswana

Samandari

Agizew²,

Nyirenda³

et al. 2015

Aids

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Objective Thirty-six months of isoniazid preventive therapy (36IPT) was superior to 6 months of IPT (6IPT) in preventing tuberculosis (TB) among HIV-infected adults in Botswana. We assessed the posttrial durability of this benefit. Design A 36-month double-blind placebo controlled trial (1 : 1 randomization) with recruitment between November 2004 and July 2006 and observation until June 2011. Methods One thousand, nine hundred and ninety-five participants were followed in eight public health clinics. Twenty-four percent had a tuberculin skin test ≥5 mm (TST-positive). A minimum CD4+ lymphocyte count was not required for enrolment. Antiretroviral therapy (ART) was provided in accordance with Botswana guidelines; 72% of participants retained by June 2011 had initiated ART. Multivariable analysis using Cox regression analysis included treatment arm, TST status, ART as a time-dependent variable and CD4+ cell count at baseline and updated at 36 months. Results In the posttrial period, 2.13 and 2.14 per 100 person-years accumulated, whereas 0.93 and 1.13% TB incidence rates were observed in the 36IPT and 6IPT arms, respectively (P = 0.52). The crude hazard ratio of TB during the trial and posttrial was 0.57 [95% confidence intervals (CI) 0.33, 0.99] and 0.82 (95% CI 0.46, 1.49), and when restricted to TST-positive participants was 0.26 (95% CI 0.08, 0.80) and 0.40 (95% CI 0.15, 1.08), respectively. Multivariable analysis showed that ART use was associated with reduced death (adjusted hazard ratio 0.36, 95% CI 0.17–0.75) but not TB (0.92, 95% CI 0.55–1.53) in the posttrial period. Conclusion The benefit of 36IPT for TB prevention declined posttrial in this cohort. Adjunctive measures are warranted to prevent TB among HIV-infected persons receiving long-term ART in TB-endemic settings.

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“…This initiative requires further implementation research. del 95% 0,03-0,28) y el hecho de recibir una reserva de isoniazida para 2 meses al comienzo del ciclo, y el factor que se asoció con un mayor riesgo de no finalizar el tratamiento fue cuando el paciente había incumplido citas médicas antes de comenzar el tratamiento (ORa 5,25; IC95% 2,(10)(11)(12)(13)14). Conclusión: Las tasas de finalización del TPI en los siete centros pilotos de Zimbabue fueron relativamente altas e indican que es factible desplegar esta iniciativa en los establecimientos públicos de salud.…”

Section: Public Health Action Ipt In Zimbabwe 59unclassified

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Takarinda

Choto

Harries

et al. 2017

public health action

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Setting: Seven pilot sites in Zimbabwe implementing 6 months of isoniazid preventive therapy (IPT) for people living with the human immunodeficiency virus (PLHIV). Objectives: To determine, among PLHIV started on IPT, the completion rates for a 6-month course of IPT and factors associated with non-adherence. Design: A retrospective cohort study. Results: Of 578 patients, 466 (81%) completed IPT. Of the 112 patients who failed to complete IPT, 69 (60%) were lost to follow-up, 30 (27%) stopped treatment with no documented reasons, 8 (7%) developed toxicity/adverse reactions, 5 (5%) were documented as having drug stock-outs and the remainder transferred out or refused to continue treatment. Currently being on antiretroviral therapy (ART) (aOR 0.09, 95%CI 0.03-0.28) and receiving a 2 month supply of isoniazid at the start of treatment were associated with a lower risk of not completing IPT, while missing clinic visits prior to starting IPT (aOR 5.25, 95%CI 2.10-13.14) was associated with a higher risk of non-completion. Conclusion: IPT completion rates in seven pilot sites of Zimbabwe were comparatively high, showing that IPT roll-out in public health facilities is feasible. Enhanced adherence counselling or active tracing among pre-ART patients and those with a history of loss to follow-up may improve IPT completion rates, along with synchronising IPT and ART resupplies. Public Health Action IPT in Zimbabwe 56the WHO-recommended four-symptom TB screening checklist. 11 If PLHIV present with any of the four symptoms, they are considered to be presumptive TB cases and sputum specimens are collected for smear microscopy or Xpert ® MTB/RIF (Cepheid, Sunnyvale, CA, USA) testing. Those patients negative on Xpert or smear microscopy and who have no other symptoms or signs of extra-pulmonary or smear-negative pulmonary TB, including chest radiography if necessary, are not recorded as having active TB. During the pilot phase, PLHIV who were not diagnosed with active TB were offered adherence counselling and were started on a daily oral dose of isoniazid (INH, 5 mg/kg body weight for adults or 10 mg/kg body weight for children) plus a daily low dose of pyridoxine (25 mg/day) for a 6-month period, regardless of their ART status. It was recommended that patients receive regular supplies of INH every month until completion of their prophylactic treatment. 10 During clinic visits, patients were assessed through self-reporting and pill counts for adherence and screened for TB. Patients found to have active TB were taken off IPT and treated according to the national TB guidelines. 11 Data on TB status (screened with no TB signs/not screened/ presumptive TB case/active TB), IPT status (yes/no), IPT quantity dispensed and reasons for starting or stopping IPT were integrated into the individual patient opportunistic infection (OI) ART care booklets and the pre-ART or ART registers, depending on the patients' ART status. This information was updated during each clinical review visit. For easier tracing of all clients enrolled on IPT, ...

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Completion of isoniazid preventive therapy and survival in HIV-infected, TST-positive adults in Tanzania

Abstract: Completion of IPT is associated with increased survival in HIV-infected adults with CD4 counts ≥ 200 cells/μ l and a positive TST.

Cited by 32 publications

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Beneficial Effect of Isoniazid Preventive Therapy and Antiretroviral Therapy on the Incidence of Tuberculosis in People Living with HIV in Ethiopia

Beneficial Effect of Isoniazid Preventive Therapy and Antiretroviral Therapy on the Incidence of Tuberculosis in People Living with HIV in Ethiopia

Tuberculosis incidence after 36 months’ isoniazid prophylaxis in HIV-infected adults in Botswana

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

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