Implementation and evaluation of an isoniazid preventive therapy pilot program among HIV-infected patients in Vietnam, 2008−2010

Abstract

Background WHO recommends screening for TB and evaluation for isoniazid preventive therapy (IPT) based on evidence that they reduce TB-related morbidity and mortality among HIV-infected persons. In Vietnam, an IPT pilot was implemented in two provinces; TB screening, treatment and outcomes were evaluated to inform the adoption and scale-up of IPT. Methods During April 2008 to March 2010, eligible HIV-infected persons aged >15 years, with no previous or current TB treatment, alcohol abuse or liver disease were screened for TB. If TB disease was ruled out based on symptoms, chest x-rays and sputum smears, isoniazid was administered for 9 months. Results Among 1281 HIV-infected persons who received initial eligibility screening, 520 were referred to and evaluated at district TB clinics for TB disease or IPT eligibility. Active TB was diagnosed in 17 patients and all were started on treatment. Of 520 patients evaluated, 416 (80.0%) initiated IPT: 382 (91.8%) completed IPT, 17 (4.1%) stopped treatment, 8 (1.9%) died, 3 (0.7%) developed TB during IPT and 6 (1.4%) had unknown outcomes. No severe adverse events were reported. Conclusions IPT treatment completion was high; no serious complications occurred. Improving and expanding intensified case-finding and IPT should be considered in Vietnam.

IPT during HIV treatment in Myanmar: high rates of coverage, completion and drug adherence

“…In less than 5 years, despite inconsistencies in supply and little history of IPT provision in Myanmar, >80% of MSF's HIV cohort was able to initiate IPT, with >90% able to complete therapy, a rate that is nearly as high as or higher than in most neighbouring countries across South and South-East Asia. 13,14,16,19,20 Myanmar thus compares well across indicators. Only one case of INH resistance was documented among 2740 patients initiating IPT.…”

“…13,14 A cohort in Viet Nam, a wealthier country with longer experience with IPT, has shown high completion rates (91.8%), with few cases of loss to follow-up (LTFU) or death. 13,15,16 Médecins Sans Frontières (MSF) has been providing HIV-TB treatment and care in southern Myanmar's Tanintharyi Region since 2004, and was one of the first actors in the country to incorporate IPT into routine HIV care. In Asia, there are some descriptions of IPT in clinical care settings, but there remains a dearth of IPT-related information from Myanmar, and recent IPT policy changes in the country require evidence surrounding the feasibility of IPT integration.…”

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

“…evaluated for TPT, and 40 (64%) of these cohorts were seen in HIV clinics. Twenty-one cohorts [17,[66][67][68][69][70][71][72][73][74][75][76][77][78][79] did not use LTBI tests, while 49 cohorts used LTBI tests; 22 used only TST, 12 used only IGRA, and 15 used either IGRA or TST. Among the 56 (80%) studies that reported the type of TPT regimen, mono-isoniazid regimens were the primary regimen prescribed in 50 cohorts (89%), and only one (2%) of the included cohorts primarily prescribed rifamycin-based short regimens (3 to months of rifampicin and isoniazid) [29].…”

The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil

“…Operational studies evaluating TB and HIV programs show the importance of identifying the challenges that underlie the provision of health services to treat both diseases. Proposing strategies for the timely diagnosis of cases as well as for monitoring and effective treatment are imperative [27][28][29][30]. Family Health Strategy coverage is considered a primary resource for improving the health of individuals in cities, as it can improve the access to health services for the population.…”