Preventive chemotherapy for HIV-associated tuberculosis in Uganda: an operational assessment at a voluntary counselling and testing centre

Aisu, T.; Raviglione, Mario C.; Praag, Eric van; Eriki, P. O.; Narain, Jai Prakash; Barugahare, Lydia; Tembo, George; McFarland, Deborah A.; Engwau, Francis Adatu

doi:10.1097/00002030-199509030-00008

Cited by 71 publications

(37 citation statements)

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“…3 The current studies' prevalence of adherence close to the upper limit of WHO's report and higher than other studies could be due to the mean number of INH tablets prescribed was 55.5 compared to the other studies who completed 6 months to 3 years of prescribed INH. 12,[13][14][15][16][17][18] The report of side effects attributed to use of INH from other studies was considered in general 12,[13][14][15][16][17][18] than the current studies' approach which tried to see each possible reported side effect and its association with adherence such as vomiting was reported most commonly than other side effects but had no statistical significance on adherence to INH for last 3, 7 or 30 days also those studies were done few years after IPT program implementation and scale up [15][16][17] where by clients' adherence could be low for a relatively new program compared to the current study.…”

Section: Discussionmentioning

confidence: 99%

Correlates of adherence and utilization of Isoniazid preventive therapy in HIV patients

Getachew¹,

Mekonnen²

2015

Journal of Microbiology and Infectious Diseases

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Objective: Isoniazid (INH) is given to individuals with latent infection of tuberculosis in order to prevent progression to active disease. It is important to understand factors associated with non-adherence to prophylactic Isoniazid. This study aimed to identify correlates of adherence and utilization of Isoniazid in HIV positive patients and to explore the opinions of patients and health care providers. Methods: Participants eligible for the study were 403 randomly selected HIV positive individuals taking INH on follow up in Yekatit 12 hospital. Adherence was measured by self-report of INH tablets taken for past 3, 7 and 30 days. In depth interview was also conducted on recruited patients and health professionals. Results: Adherence to INH was 94% for last 7 days. INH related common side effects were reported by 142 participants (35.2%) and only 53 (13.2%) discontinued. The odds of adherence was 104, 7.7 and 34.8 [95% Confidence Interval (18.7, 582.6), (2.6, 22.9) and (4.4, 272.6)] times higher among those patients who did not have jaundice, skin rash and seizure compared to those who developed, respectively. Conclusion: The prevalence of adherence to INH in Yekatit 12 hospital was better than other local and African studies and the reasons for poor adherence was strongly associated with occurrence of jaundice, skin rash and seizure. Comprehensive care and support, sustainable drug supply and evaluation of side effects are recommended.

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Section: Discussionmentioning

confidence: 99%

Correlates of adherence and utilization of Isoniazid preventive therapy in HIV patients

Getachew¹,

Mekonnen²

2015

Journal of Microbiology and Infectious Diseases

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“…11 Operational impediments to TB screening and preventive therapy and limitations in the adherence to the different steps of TB screening are common to TB control programs throughout the world. 14,15,57 In our setting, the major limiting step was that of referral for off-site CXRs. This diminished the potential of the TB screening to identify candidates for preventive therapy and thus decreased, but did not eliminate, the clinical value and cost-effectiveness of the TB screening and DOPT.…”

Section: Discussionmentioning

confidence: 99%

“…However, TB screening and preventive therapy are multistep interventions, and the completion of TB screening and adherence to preventive therapy remain problematic in many settings and for many populations, including, but not limited to, drug users. 2,[14][15][16] The completion rates for INH preventive therapy range from 20% to 69%. 17,18 Directly observed preventive therapy (DOPT), a valuable strategy in improving adherence and completion of therapy rates for persons with active TB, has also been suggested as a means of improving adherence to preventive therapy.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Tuberculosis Screening and Observed Preventive Therapy for Active Drug Injectors at a Syringe-Exchange Program

Perlman

Gourevitch

Trinh

et al. 2001

Journal of Urban Health: Bulletin of the New York Academy of Medicine

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This study examined whether costs associated with tuberculosis (TB) screening and directly observed preventive therapy (DOPT) among drug injectors attending a syringe exchange are justified by cases and costs of active TB cases prevented and examined the impact of monetary incentives to promote adherence on cost-effectiveness. We examined program costs and projected savings using observed adherence and prevalence rates and literature estimates of isoniazid (INH) preventive therapy efficacy, expected INH hepatoxicity rates, and TB treatment costs; we conducted sensitivity analyses for a range of INH effectiveness, chest X-ray (CXR) referral adherence, and different strategies regarding anergy among persons affected with human immunodeficiency virus (HIV). For 1,000 patients offered screening, incorporating real observed program adherence rates, the program would avert $179,934 in TB treatment costs, for a net savings of $123,081. Assuming a modest risk of TB among HIV-infected anergic persons, all strategies with regard to anergy were cost saving, and the strategy of not screening for anergy and not providing DOPT to HIV-infected anergic persons resulted in the greatest cost savings. If an incentive of $25 per person increased CXR adherence from the observed 31% to 50% or 100%, over a 5-year follow-up the net cost savings would increase to $170,054 and $414,856, respectively. In this model, TB screening and DOPT at a syringe exchange is a cost-effective intervention and is cost-saving compared to costs of treating active TB cases that would have occurred in the absence of the intervention. This model is useful in evaluating the cost impact of planned program refinements, which can then be tested. Monetary incentives for those referred for screening CXRs would be justified on a cost basis if they had even a modest beneficial impact on adherence.

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“…68 Adherence to medication is then critical for ensuring effectiveness of IPT, and it is well recognized that adherence to preventive treatment is more difficult to achieve than adherence to curative therapy. Many studies on IPT among PLHIV have reported low rates of treatment completion (e.g., 53% in Uganda in the pre-ART era and 64% in Ethiopia 69,70 and completion rates under programmatic rather than study conditions are likely to be even lower. PLHIV already receive a high number of pills.…”

Section: How Should Programmes Organize the Initiation Of Ipt?mentioning

confidence: 99%

Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries

Harries

Schwoebel

Monedero-Recuero

et al. 2019

int j tuberc lung dis

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Preventive chemotherapy for HIV-associated tuberculosis in Uganda: an operational assessment at a voluntary counselling and testing centre

Cited by 71 publications

References 0 publications

Correlates of adherence and utilization of Isoniazid preventive therapy in HIV patients

Correlates of adherence and utilization of Isoniazid preventive therapy in HIV patients

Cost-Effectiveness of Tuberculosis Screening and Observed Preventive Therapy for Active Drug Injectors at a Syringe-Exchange Program

Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries

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