Isoniazid Preventive Therapy for Prevention of Tuberculosis among People Living with HIV in Ethiopia: A Systematic Review of Implementation and Impacts

Abstract

Background: Tuberculosis (TB) is a major cause of morbidity and mortality in people living with HIV (PLWHIV). Isoniazid preventive therapy (IPT) prevents TB in PLWHIV, but estimates of its effects and actual implementation vary across countries. We reviewed studies that examined the impact of IPT on PLHIV and the factors influencing its implementation in Ethiopia. Methods: We searched PubMed/MEDLINE, Embase, and the Cochrane Central Register of Clinical Controlled Trials from their inception to 1 April 2021 for studies of any design that examined the impact of IPT on PLHIV and the factors influencing its implementation. The protocol was registered in PROSPERO, ID: CRD42021256579. Result: Of the initial 546 studies identified, 13 of which enrolled 12,426 participants, 15,640 PLHIV and 62 HIV clinical care providers were included. PLHIV who were on IPT, independently or simultaneously with ART, were less likely to develop TB than those without IPT. IPT interventions had a significant association with improved CD4 count and reduced all-cause mortality. IPT was less effective in people with advanced HIV infection. The major factors influencing IPT implementation and uptake were stock-outs, fear of developing isoniazid-resistant TB, patient’s refusal and non-adherence, and improper counseling and low commitment of HIV clinical care providers. Conclusion: IPT alone or in combination with ART significantly reduces the incidence of TB and mortality in PLHIV in Ethiopia than those without IPT. More research on safety is needed, especially on women with HIV who receive a combination of IPT and ART. Additionally, studies need to be conducted to investigate the efficacy and safety of the new TPT (3 months combination of isoniazid and rifapentine) in children and people living with HIV.

Proportion of active tuberculosis among HIV-infected children after antiretroviral therapy in Ethiopia: A systematic review and meta-analysis

“…Consistent with previous studies finding in [ 12 , 17 , 32 , 33 , 38 , 57 – 60 ],concurrent administering of IPT after ruled-out of active TB symptoms with ART demoted more than 90% of active TB-associated incidence of morbidity [ 3 , 61 , 62 ]. In the final report of this systematic review and meta-analysis, it was found that HIV-infected children who did not receive IPT (preventive therapy) were at a twofold higher risk compared to the control group.…”

Synthesis and Structural Characterization of Novel Dimers of Dipyridothiazine as Promising Antiproliferative Agents

“…Heterocyclic systems play an essential role in medicinal chemistry and are related to the search for valuable new drug candidates [5,6]. One of the most biologically active cores is a six-membered pyridine ring, which is a building block found in many medicinal substances, such as sorafenib, zapiclone, isoniazid, tazarotene and bromazepam [7][8][9][10][11]. At the same time, it should be remembered that its derivatives also include nicotine, vitamin PP and the nucleotides NADH and NAD+ [12][13][14].…”

Analysis of spatial characteristics and geographic weighted regression of tuberculosis prevalence in Kashgar, China

“…Spatial autocorrelation is mainly applied to study the spatial correlation between geographical factors, which contains both global and local spatial autocorrelation ( Assefa, 2022 ). In this paper, we applied Moran's I index to study the regional correlation of tuberculosis in Kashgar and explored the spatial aggregation pattern of tuberculosis in the region using LISA index.…”