1
|
Ross JM, Greene C, Broshkevitch CJ, Dowdy DW, van Heerden A, Heitner J, Rao DW, Roberts DA, Shapiro AE, Zabinsky ZB, Barnabas RV. Preventing tuberculosis with community-based care in an HIV-endemic setting: a modelling analysis. J Int AIDS Soc 2024; 27:e26272. [PMID: 38861426 PMCID: PMC11166187 DOI: 10.1002/jia2.26272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/30/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) and tuberculosis preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase the uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men. METHODS We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15-59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programmes during 2018-2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e. ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for 10 years. We projected the number of TB cases, deaths and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated programme costs and incremental cost-effectiveness ratios from the provider perspective. RESULTS If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3%-34.1%) and TB mortality by 34.6% (range 24.8%-42.2%) after 10 years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9%-36.0%) and TB mortality by 36.0% (range 26.9%-43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates, with a projected 54 more deaths annually among men than women (range 11-103) after 10 years of community-based care versus 109 (range 41-182) in standard care. Over 10 years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709-$1012). CONCLUSIONS By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.
Collapse
Affiliation(s)
- Jennifer M. Ross
- Division of Allergy and Infectious DiseasesDepartment of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Chelsea Greene
- Department of Industrial and Systems EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Cara J. Broshkevitch
- Department of EpidemiologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - David W. Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Alastair van Heerden
- Centre for Community Based ResearchHuman Sciences Research CouncilPietermaritzburgSouth Africa
- SAMRC/Wits Developmental Pathways for Health Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Jesse Heitner
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
| | - Darcy W. Rao
- Bill & Melinda Gates FoundationSeattleWashingtonUSA
| | - D. Allen Roberts
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Adrienne E. Shapiro
- Division of Allergy and Infectious DiseasesDepartment of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Zelda B. Zabinsky
- Department of Industrial and Systems EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Ruanne V. Barnabas
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
2
|
Amanya I, Muhoozi M, Aruhomukama D, Ssebagereka A, Mugambe R. Isoniazid preventive therapy completion and factors associated with non-completion among patients on antiretroviral therapy at Kisenyi Health Centre IV, Kampala, Uganda. PLoS One 2023; 18:e0277739. [PMID: 37607176 PMCID: PMC10443854 DOI: 10.1371/journal.pone.0277739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Isoniazid preventive therapy (IPT) is given to HIV patients to reduce the risk of active tuberculosis (TB). However, treatment completion remains suboptimal among those that are initiated. This study aimed to determine the completion level of IPT and the factors associated with non-completion among patients on antiretroviral therapy (ART) at Kisenyi Health Center IV in Kampala, Uganda. METHODS A mixed-methods facility-based retrospective cohort study utilizing routinely collected data from 341 randomly selected HIV patients initiated on IPT was conducted. Data extracted from the registers was used to determine IPT completion. Robust Poisson regression was conducted to determine the associated factors of IPT non-completion, while in-depth interviews were conducted to explore barriers to IPT completion from the patient's perspective. RESULTS A total of 341 patients who started on isoniazid (INH) were retrospectively followed up, with 69% (236/341) being female. Overall IPT completion was 83%. Multivariate analysis revealed the prevalence of IPT non-completion among males was 2.24 times the prevalence among females (aPR 2.24, 95% CI: 1.40-3.58, p = 0.001). The prevalence of IPT non-completion among patients with a non-suppressed HIV viral load was 3.00 times the prevalence among those with a suppressed HIV viral load (aPR 3.00, 95% CI: 1.44-6.65, p = 0.007). The prevalence of IPT non-completion among patients who were married, or cohabiting was 0.31 times the prevalence among those who were single (aPR 0.31, 95% CI: 0.17-0.55, p<0.000). Lack of IPT-related health education, pill burden, distance to the health facility, and patient relocation were reported as barriers to IPT completion. CONCLUSION IPT completion was found to be 83% among the cohort studied. However, lower completion levels persist among males and HIV-virally non-suppressed patients. Lack of IPT-related health education, pill burden, distance to the health facility, and patient relocation were reported as barriers to IPT completion. Interventions that target these groups of people need to be intensified.
Collapse
Affiliation(s)
- Ian Amanya
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Brainmann Analytics, Kampala, Uganda
| | - Michael Muhoozi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dickson Aruhomukama
- Brainmann Analytics, Kampala, Uganda
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anthony Ssebagereka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
3
|
Ross JM, Greene C, Bayer CJ, Dowdy DW, van Heerden A, Heitner J, Rao DW, Roberts DA, Shapiro AE, Zabinsky ZB, Barnabas RV. Preventing tuberculosis with community-based care in an HIV-endemic setting: a modeling analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.21.23294380. [PMID: 37662260 PMCID: PMC10473784 DOI: 10.1101/2023.08.21.23294380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Introduction Antiretroviral therapy (ART) and TB preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men. Methods We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15-59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programs during 2018-2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e., ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for ten years. We projected the number of TB cases, deaths, and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated program costs and incremental cost-effectiveness ratios from the provider perspective. Results If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3% - 34.1%) and TB mortality by 36.0% (range 26.9% - 43.8%) after ten years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9% - 36.0%) and TB mortality by 36.0% (range 26.9% - 43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates by reducing TB mortality among men by a projected 39.8% (range 32.2% - 46.3%) and by 30.9% (range 25.3% - 36.5%) among women. Over ten years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709 - $1,012). Conclusions By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.
Collapse
Affiliation(s)
- Jennifer M. Ross
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
| | - Chelsea Greene
- Department of Industrial and Systems Engineering, University of Washington, Seattle, USA
| | - Cara J. Bayer
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Jesse Heitner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
| | | | - D. Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Adrienne E. Shapiro
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Zelda B. Zabinsky
- Department of Industrial and Systems Engineering, University of Washington, Seattle, USA
| | - Ruanne V. Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| |
Collapse
|
4
|
Factors associated with isoniazid preventive treatment interruption and completion among PLHIV in Gombe Hospital, Uganda, 2017–2019. J Clin Tuberc Other Mycobact Dis 2023; 31:100349. [PMID: 37181458 PMCID: PMC10173270 DOI: 10.1016/j.jctube.2023.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Tuberculosis (TB) is the leading cause of death in persons living with HIV (PLHIV). PLHIV carry a disproportionate burden of TB infection with risks 20-37 times greater than HIV-negative populations. While isoniazid preventive treatment (IPT) is regarded as a crucial component of HIV care to prevent active TB, the uptake among PLHIV remains very poor. Studies on the factors associated with IPT interruption and completion among PLHIV in Uganda are scarce. Thus, in Gombe Hospital in Uganda, this study assessed the factors associated with IPT interruption and completion among PLHIV. Methods This was a hospital-based cross-sectional study that used both quantitative and qualitative methods of data collection from January 3rd, 2020 to February 28th, 2020. We reviewed the medical records of 686 PLHIV who received IPT at Gombe Hospital from January 1st, 2017 to December 31st, 2019. Binary logistic and modified Poisson regression were used to analyze factors associated with IPT completion and interruption. We conducted 7 key informant interviews and 14 in-depth interviews. Results Second-line antiretroviral therapy (AOR = 46, p < 0.001) and age ≥ 45 years (AOR = 0.2, p = 0.040) were significantly associated with IPT interruption, while attending routine ART counseling sessions (APR = 1.5, p < 0.001) and prescription for ≥ 2 months at the start of IPT (APR = 1.1, p = 0.010) were associated with IPT completion. Barriers to IPT completion included pill burden, forgetfulness, poor integration of IPT in HIV healthcare services, and lack of awareness of IPT, while facilitators were easy accessibility of IPT and support from implementing partners. Conclusions Side effects and pill burden were the major barriers to the long-term completion of IPT. Supplying ≥ 2 months IPT drugs, using IPT drugs with fewer side effects, and counseling during IPT could improve IPT completion and reduce IPT interruption.
Collapse
|
5
|
Mukumbwa-Mwenechanya M, Mubiana M, Somwe P, Zyambo K, Simwenda M, Zongwe N, Kalunkumya E, Mwango LK, Rabkin M, Mpesela F, Chungu F, Mwanza F, Preko P, Bolton-Moore C, Bosomprah S, Sharma A, Morton K, Kasonde P, Mulenga L, Lingu P, Mulenga PL. Integrating isoniazid preventive therapy into the fast-track HIV treatment model in urban Zambia: A proof-of -concept pilot project. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000909. [PMID: 36962979 PMCID: PMC10021523 DOI: 10.1371/journal.pgph.0000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/26/2023] [Indexed: 03/26/2023]
Abstract
Most people living with HIV (PLHIV) established on treatment in Zambia receive multi-month prescribing and dispensing (MMSD) antiretroviral therapy (ART) and are enrolled in less-intensive differentiated service delivery (DSD) models such as Fast Track (FT), where clients collect ART every 3-6 months and make clinical visits every 6 months. In 2019, Zambia introduced Isoniazid Preventive Therapy (IPT) with scheduled visits at 2 weeks and 1, 3, and 6 months. Asynchronous IPT and HIV appointment schedules were inconvenient and not client centered. In response, we piloted integrated MMSD/IPT in FT HIV treatment model. We implemented and evaluated a proof-of-concept project at one purposively selected high-volume facility in Lusaka, Zambia between July 2019 and May 2020. We sensitized stakeholders, adapted training materials, standard operating procedures, and screened adults in FT for TB as per national guidelines. Participants received structured TB/IPT education, 6-month supply of isoniazid and ART, aligned 6th month IPT/MMSD clinic appointment, and phone appointments at 2 weeks and months 1-5 following IPT initiation. We used descriptive statistics to characterize IPT completion rates, phone appointment keeping, side effect frequency and Fisher's exact test to determine variation by participant characteristics. Key lessons learned were synthesized from monthly meeting notes. 1,167 clients were screened with 818 (70.1%) enrolled, two thirds (66%) were female and median age 42 years. 738 (90.2%) completed 6-month IPT course and 66 (8.1%) reported IPT-related side effects. 539 clients (65.9%) attended all 7 telephone appointments. There were insignificant differences of outcomes by age or sex. Lessons learnt included promoting project ownership, client empowerment, securing supply chain, adapting existing processes, and cultivating collaborative structured learning. Integrating multi-month dispensing and telephone follow up of IPT into the FT HIV treatment model is a promising approach to scaling-up TB preventive treatment among PLHIV, although limited by barriers to consistent phone access.
Collapse
Affiliation(s)
| | - Muhau Mubiana
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | | | | | | | | | | | - Miriam Rabkin
- ICAP at Columbia University and Departments of Medicine & Epidemiology, New York, New York, United States of America
- Columbia University Mailman School of Public Health, New York, New York, United States of America
| | | | - Fred Chungu
- Network of Zambian People Living with HIV, Lusaka, Zambia
| | - Felix Mwanza
- Treatment Advocacy and Literacy Campaign, Lusaka, Zambia
| | - Peter Preko
- ICAP at Columbia University, Mbabane, Eswatini
| | - Carolyn Bolton-Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Samuel Bosomprah
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Anjali Sharma
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | | | | | | | | | | |
Collapse
|
6
|
Tsirizani-Galileya L, Milanzi E, Mungwira R, Divala T, Mallewa J, Mategula D, Nampota N, Mwapasa V, Buchwald A, Laurens MB, Laufer MK, Van Oosterhout JJ. Isoniazid preventive therapy-related adverse events among Malawian adults on antiretroviral therapy: A cohort study. Medicine (Baltimore) 2022; 101:e30591. [PMID: 36181120 PMCID: PMC9524894 DOI: 10.1097/md.0000000000030591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Adverse events may be a cause of observed poor completion of isoniazid preventive therapy (IPT) among people living with HIV in high tuberculosis burden areas. Data on IPT-related adverse events (AE) from sub-Saharan Africa are scarce. We report IPT-related AEs, associated clinical characteristics, and IPT discontinuations in adults who were stable on antiretroviral therapy (ART) when they initiated IPT. Cohort study nested within a randomized, controlled, clinical trial of cotrimoxazole and chloroquine prophylaxis in Malawians aged ≥ 18 years and virologically suppressed on ART. Eight hundred sixty-nine patients were followed for a median of 6 months after IPT initiation. IPT relatedness of AEs was determined retrospectively with the World Health Organization case-causality tool. Frailty survival regression modeling identified factors associated with time to first probably IPT-related AE. The overall IPT-related AE incidence rate was 1.1/person year of observation. IPT relatedness was mostly uncertain and few AEs were severe. Most common were liver and hematological toxicities. Higher age increased risk of a probably IPT-related AE (aHR = 1.02; 95% CI 1.00-1.06; P = .06) and higher weight reduced this risk (aHR = 0.98; 95% CI 0.96-1.00; P = .03). Of 869 patients, 114 (13%) discontinued IPT and 94/114 (82%) discontinuations occurred at the time of a possibly or probably IPT-related AE. We observed a high incidence of mostly mild IPT-related AEs among individuals who were stable on ART. More than 1 in 8 persons discontinued IPT. These findings inform strategies to improve implementation of IPT in adults on ART, including close monitoring of groups at higher risk of IPT-related AEs.
Collapse
Affiliation(s)
| | - Elasma Milanzi
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Randy Mungwira
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Titus Divala
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jane Mallewa
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Donnie Mategula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nginache Nampota
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Mwapasa
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andrea Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew B. Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Miriam K. Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joep J. Van Oosterhout
- Dignitas International, Zomba, Malawi
- Partners in Hope, Lilongwe, Malawi & Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- *Correspondence: Joep J van Oosterhout, Partners in Hope, PO Box 302, Lilongwe, Malawi (e-mail: )
| |
Collapse
|
7
|
Gupta A, Sun X, Krishnan S, Matoga M, Pierre S, Mcintire K, Koech L, Faesen S, Kityo C, Dadabhai SS, Naidoo K, Samaneka WP, Lama JR, Veloso VG, Mave V, Lalloo U, Langat D, Hogg E, Bisson GP, Kumwenda J, Hosseinipour MC. Isoniazid adherence reduces mortality and incident tuberculosis at 96 weeks among adults initiating antiretroviral therapy with advanced HIV in multiple high burden settings. Open Forum Infect Dis 2022; 9:ofac325. [PMID: 35899273 PMCID: PMC9314898 DOI: 10.1093/ofid/ofac325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/01/2022] [Indexed: 12/01/2022] Open
Abstract
Background People with human immunodeficiency virus (HIV) and advanced immunosuppression initiating antiretroviral therapy (ART) remain vulnerable to tuberculosis (TB) and early mortality. To improve early survival, isoniazid preventive therapy (IPT) or empiric TB treatment have been evaluated; however, their benefit on longer-term outcomes warrants investigation. Methods We present a 96-week preplanned secondary analysis among 850 ART-naive outpatients (≥13 years) enrolled in a multicountry, randomized trial of efavirenz-containing ART plus either 6-month IPT (n = 426) or empiric 4-drug TB treatment (n = 424). Inclusion criteria were CD4 count <50 cells/mm3 and no confirmed or probable TB. Death and incident TB were compared by strategy arm using the Kaplan-Meier method. The impact of self-reported adherence (calculated as the proportion of 100% adherence) was assessed using Cox-proportional hazards models. Results By 96 weeks, 85 deaths and 63 TB events occurred. Kaplan-Meier estimated mortality (10.1% vs 10.5%; P = .86) and time-to-death (P = .77) did not differ by arm. Empiric had higher TB risk (6.1% vs 2.7%; risk difference, −3.4% [95% confidence interval, −6.2% to −0.6%]; P = .02) and shorter time to TB (P = .02) than IPT. Tuberculosis medication adherence lowered the hazards of death by ≥23% (P < .0001) in empiric and ≥20% (P < .035) in IPT and incident TB by ≥17% (P ≤ .0324) only in IPT. Conclusions Empiric TB treatment offered no longer-term advantage over IPT in our population with advanced immunosuppression initiating ART. High IPT adherence significantly lowered death and TB incidence through 96 weeks, emphasizing the benefit of ART plus IPT initiation and completion, in persons with advanced HIV living in high TB-burden, resource-limited settings.
Collapse
Affiliation(s)
- Amita Gupta
- Johns Hopkins University , Baltimore, MD , USA
| | - Xim Sun
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | | | | | | | | | - Lucy Koech
- Kenya Medical Research Institute (KEMRI)/Walter Reed Project , Kericho , Kenya
| | - Sharlaa Faesen
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa
| | - Cissy Kityo
- Joint Clinical Research Centre , Kampala , Uganda
| | - Sufia S Dadabhai
- Johns Hopkins University , Baltimore, MD , USA
- College of Medicine-Johns Hopkins Research Project , Blantyre , Malawi
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban , South Africa
- Medical Research Council (MRC)-CAPRISA-HIV-TB Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine , Durban , South Africa
| | | | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion , Lima , Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas/FIOCRUZ , Rio de Janeiro , Brazil
| | - Vidya Mave
- Johns Hopkins University , Baltimore, MD , USA
| | - Umesh Lalloo
- Enhancing Care Foundation, Durban University of Technology , Durban , South Africa
| | - Deborah Langat
- Kenya Medical Research Institute (KEMRI)/Walter Reed Project , Kericho , Kenya
| | - Evelyn Hogg
- Social & Scientific Systems, Inc., a DLH Holdings Company , Silver Spring, MD , USA
| | - Gregory P Bisson
- University of Pennsylvania Perelman School of Medicine , Philadelphia, PA , USA
| | | | - Mina C Hosseinipour
- 3UNC Project , Lilongwe , Malawi
- University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC , USA
| | | |
Collapse
|
8
|
Kazibwe A, Oryokot B, Mugenyi L, Kagimu D, Oluka AI, Kato D, Ouma S, Tayebwakushaba E, Odoi C, Kakumba K, Opito R, Mafabi CG, Ochwo M, Nkabala R, Tusiimire W, Kateeba Tusiime A, Alinga SB, Miya Y, Etukoit MB, Biraro IA, Kirenga B. Incidence of tuberculosis among PLHIV on antiretroviral therapy who initiated isoniazid preventive therapy: A multi-center retrospective cohort study. PLoS One 2022; 17:e0266285. [PMID: 35576223 PMCID: PMC9109920 DOI: 10.1371/journal.pone.0266285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Isoniazid preventive therapy (IPT) is effective in treating tuberculosis (TB) infection and hence limiting progression to active disease. However, the durability of protection, associated factors and cost-effectiveness of IPT remain uncertain in low-and-middle income countries, Uganda inclusive. The Uganda Ministry of health recommends a single standard-dose IPT course for eligible people living with HIV (PLHIV). In this study we determined the incidence, associated factors and median time to TB diagnosis among PLHIV on Antiretroviral therapy (ART) who initiated IPT. Materials and methods We conducted a retrospective cohort study at eleven The AIDS Support Organization (TASO) centers in Uganda. We reviewed medical records of 2634 PLHIV on ART who initiated IPT from 1st January 2016 to 30th June 2018, with 30th June 2021 as end of follow up date. We analyzed study data using STATA v.16. Incidence rate was computed as the number of new TB cases divided by the total person months. A Frailty model was used to determine factors associated with TB incidence. Results The 2634 individuals were observed for 116,360.7 person months. IPT completion rate was 92.8%. Cumulative proportion of patients who developed TB in this cohort was 0.83% (22/2634), an incidence rate of 18.9 per 100,000 person months. The median time to TB diagnosis was 18.5 months (minimum– 0.47; maximum– 47.3, IQR: 10.1–32.4). World Health Organization (WHO) HIV clinical stage III (adjusted hazard ratio (aHR) 95%CI: 3.66 (1.08, 12.42) (P = 0.037) and discontinuing IPT (aHR 95%CI: 25.96(4.12, 169.48) (p = 0.001)), were associated with higher odds of TB diagnosis compared with WHO clinical stage II and IPT completion respectively. Conclusion Incidence rates of TB were low overtime after one course of IPT, and this was mainly attributed to high completion rates.
Collapse
Affiliation(s)
- Andrew Kazibwe
- The AIDS Support Organization (TASO), Kampala, Uganda
- Makerere University School of Medicine, Kampala, Uganda
| | - Bonniface Oryokot
- The AIDS Support Organization (TASO), Kampala, Uganda
- University of Suffolk, Ipswich, United Kingdom
- * E-mail:
| | | | - David Kagimu
- The AIDS Support Organization (TASO), Kampala, Uganda
| | | | - Darlius Kato
- The AIDS Support Organization (TASO), Kampala, Uganda
| | - Simple Ouma
- The AIDS Support Organization (TASO), Kampala, Uganda
| | | | - Charles Odoi
- The AIDS Support Organization (TASO), Kampala, Uganda
| | | | - Ronald Opito
- The AIDS Support Organization (TASO), Kampala, Uganda
| | | | - Michael Ochwo
- The AIDS Support Organization (TASO), Kampala, Uganda
| | | | | | | | | | - Yunus Miya
- The AIDS Support Organization (TASO), Kampala, Uganda
| | | | | | - Bruce Kirenga
- Makerere University School of Medicine, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| |
Collapse
|
9
|
Oonyu L, Kang S, Konlan KD, Kang YA. Isoniazid Preventive Therapy for Tuberculosis in People Living with HIV: A Cross Sectional Study in Butebo, Uganda. Infect Chemother 2022; 54:70-79. [PMID: 35384419 PMCID: PMC8987171 DOI: 10.3947/ic.2021.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/22/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Sunjoo Kang
- Department of Global Health, Graduate School of Public Health Yonsei University, Seoul, Korea
| | - Kennedy Diema Konlan
- Mo-im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Boyd AT, Lodiongo DK, Benson JM, Aragaw S, Pasquale MS, Ayalneh H, Olemukan R, Avaku I, Baabe N, Achut V, Chun H, Bunga S. Implementation of tuberculosis preventive treatment among people living with HIV, South Sudan. Bull World Health Organ 2020; 99:34-40. [PMID: 33716332 DOI: 10.2471/blt.20.254789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/27/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To describe an intervention to scale up tuberculosis preventive treatment for people living with human immunodeficiency virus (HIV) in South Sudan, 2017-2020. Methods Staff of the health ministry and United States President's Emergency Plan for AIDS Relief designed an intervention targeting the estimated 30 400 people living with HIV on antiretroviral therapy across South Sudan. The intervention comprised: (i) developing sensitization and operational guidance for clinicians to put tuberculosis preventive treatment delivery into clinical practice; (ii) disseminating monitoring and evaluation tools to document scale-up; (iii) implementing a programmatic pilot of tuberculosis preventive treatment; and (iv) identifying a mechanism for procurement and delivery of isoniazid to facilities dispensing tuberculosis preventive treatment. Staff aggregated routine programme data from facility registers on the numbers of people living with HIV who started on tuberculosis preventive treatment across all clinical sites providing this treatment during July 2019-March 2020. Findings Tuberculosis preventive treatment was implemented in 13 HIV treatment sites during July-October 2019, then in 26 sites during November 2019-March 2020. During July 2019-March 2020, 6503 people living with HIV started tuberculosis preventive treatment. Conclusion Lessons for other low-resource settings may include supplementing national guidelines with health ministry directives, clinician guidance and training, and an implementation pilot. A cadre of field supervisors can rapidly disseminate a standardized approach to implementation and monitoring of tuberculosis preventive treatment, and this approach can be used to strengthen other tuberculosis-HIV services. Procuring a reliable and steady supply of tuberculosis preventive treatment medication is crucial.
Collapse
Affiliation(s)
- Andrew T Boyd
- Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road NE, US1-1, Atlanta, GA 30329, United States of America
| | - Dennis Kenyi Lodiongo
- Division of Global HIV and TB, Centers for Disease Control and Prevention (South Sudan), Juba, South Sudan
| | - John Mondi Benson
- Division of Global HIV and TB, Centers for Disease Control and Prevention (South Sudan), Juba, South Sudan
| | - Shambel Aragaw
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba, South Sudan
| | | | - Habtamu Ayalneh
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba, South Sudan
| | - Robert Olemukan
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba, South Sudan
| | - Isaac Avaku
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba Teaching Hospital, Juba, South Sudan
| | - Nicholas Baabe
- United States Agency for International Development (South Sudan), Juba, South Sudan
| | - Victoria Achut
- HIV/AIDS/STI Directorate, Ministry of Health, Juba, South Sudan
| | - Helen Chun
- Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road NE, US1-1, Atlanta, GA 30329, United States of America
| | - Sudhir Bunga
- Division of Global HIV and TB, Centers for Disease Control and Prevention (South Sudan), Juba, South Sudan
| |
Collapse
|