The effect of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected clients under pre-ART care, Jimma, Ethiopia: a retrospective cohort study

Abstract

BackgroundTuberculosis (TB) is a major public health problem that accounts for almost half a million human immunodeficiency virus (HIV) associated deaths. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB in HIV infected individuals. However, in Ethiopia, the coverage and implementation of IPT is limited. The objective of this study is to compare the incidence rate of TB, TB-free survival time and identify factors associated with development TB among HIV-infected individuals on pre-ART follow up.MethodsA retrospective cohort study was conducted from January, 2008 to February 31, 2012 in Jimma hospital. Kaplan-Meier survival plots were used to calculate the crude effect in both groups on TB-free survival probabilities and compared using the log rank test. A Cox proportional hazard model was used to identify predictors of TB.ResultA total of 588 patients on pre-ART care (294 IPT and 294 non-IPT group) were followed retrospectively for a median duration of 24.1 months. The median CD4+ cell count was 422 cells/μl (IQR 344 – 589). During the follow up period, 49 individuals were diagnosed with tuberculosis, giving an overall incidence of 3.78 cases per 100 person year (PY). The incidence rate of TB was 5.06 per 100 PY in non-IPT group and 2.22 per 100 PY in IPT user group. Predictors of higher TB risk were: being on clinical WHO stage III/IV (adjusted hazard ratio (AHR = 3.05, 95% confidence interval (CI): 1.61, 5.81); non-IPT user (AHR = 2.02, 95% CI: 1.04, 3.92); having CD4+ cell count less than 350 cells/μl (AHR = 3.16, 95% CI: 1.04, 3.92) and between 350–499 cells/μl, (AHR = 2.87; 95% CI: 1.37 - 6.03) and having episode of opportunistic infection (OI) in the past (AHR = 2.41, 95% CI: 1.33-4.34).ConclusionIPT use was associated with fifty percent reduction in new cases of tuberculosis and probability of developing TB was higher in non-IPT group. Implementing the widespread use of IPT has the potential to reduce TB rates substantially among HIV-infected individuals in addition to other tuberculosis prevention and control effort in resource limited settings.

Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

“…Patients who had not taken IPT were more likely to develop TB as compared to those who took IPT. This finding is congruent with previous studies conducted in different parts of Ethiopia [17,18,22,36], which may reflect the role of IPT in reducing the occurrence of TB among PLHIV [16,38]. As a result, all HIV positive individuals who have no evidence of active TB infection should be taking IPT to prevent TB infection.…”

“…For example, the Ministry of Health (MOH) decentralized TB/HIV co-infection care services from hospitals to health centers and strengthened referral systems to improve TB care and treatment at the community level [13]. In addition, early initiation of ART and early screening of TB, prior to provision of Isonized Preventive Therapy (IPT) [14,15] and Cotrimoxazole Prophylactic Therapy (CPT), were interventions implemented to reduce the incidence of TB among PLHIV [16][17][18][19][20].…”

Incidence and Predictors of Tuberculosis Occurrence among Adults on Antiretroviral Therapy at Debre Markos Referral Hospital, Northwest Ethiopia: Retrospective Follow-up Study

“…This might be due to the synergist role of IPT and ART drug in reducing the incidence of TB among PLHIV. Introduction of IPT to those patients on ART reduces the mycobacterium load which intern reduces the progression of latent TB to active one (32)(33)(34). This finding is consistent with those studies in Ethiopia (17, 28, 35, 36).…”

Bayesian hierarchical modeling of joint spatiotemporal risk patterns for Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) in Kenya

“…Similar studies in Sub-Saharan Africa that utilized routinely collected data observed similar temporal dynamics [55][56][57][58]. A possible explanation could be HIV drives TB related incidences, therefore, the incidence and prevalence of TB increases (decreases) with increasing (decreasing) HIV trends [59][60][61].…”