A re-examination of the potential impact of preventive therapy on the public health problem of tuberculosis in contemporary sub-Saharan Africa

Guwatudde, David; Debanne, Sara M.; Diaz, M; King, Charles H.; Whalen, Christopher C.

doi:10.1016/j.ypmed.2004.04.008

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…A number of trials and modeling analyses performed in sub-Saharan Africa have suggested that IPT may have limited population-level impact in that setting. 13,14,23,24 Our model suggests that the larger relative impact in moderate-burden settings such as urban Brazil may in part reflect differential risks of infection. In our model, the measured TB incidence rate among adults in Rio de Janeiro suggests an annual risk of TB infection (ARTI) of 0.8% – a risk that may be five times greater in hyperendemic settings in southern Africa.…”

Section: Discussionmentioning

confidence: 88%

Impact of Isoniazid Preventive Therapy for HIV-Infected Adults in Rio de Janeiro, Brazil

Dowdy

Golub

Saraceni³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background The potential epidemiological impact of isoniazid preventive therapy (IPT), delivered at levels that could be feasibly scaled up among people living with HIV (PLHIV) in modern, moderate-burden settings, remains uncertain. Methods We used routine surveillance and implementation data from a cluster-randomized trial of IPT among HIV-infected clinic patients with good access to antiretroviral therapy in Rio de Janeiro, Brazil, to populate a parsimonious transmission model of TB/HIV. We modeled IPT delivery as a constant process capturing a proportion of the eligible population every year. We projected feasible reductions in tuberculosis (TB) incidence and mortality in the general population and among PLHIV specifically at the end of five years after implementing an IPT program. Results Data on time to IPT fit an exponential curve well, suggesting that IPT was delivered at a rate covering 20% (95% confidence interval: 16%, 24%) of the 2,500 eligible individuals each year. By the end of year 5 after modeled program roll-out, IPT had reduced TB incidence by 3.0% (95% uncertainty range, UR: 1.6%, 7.2%) in the general population and by 15.6% (95%UR: 15.5%, 36.5%) among PLHIV. Corresponding reductions in TB mortality were 4.0% (95%UR: 2.2%, 10.3%) and 14.3% (14.6%, 33.7%). Results were robust to wide variations in parameter values on sensitivity analysis. Conclusions TB screening and IPT delivery can substantially reduce TB incidence and mortality among PLHIV in urban, moderate-burden settings. In such settings, IPT can be an important component of a multi-faceted strategy to feasibly reduce the burden of TB in PLHIV.

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Section: Discussionmentioning

confidence: 88%

Impact of Isoniazid Preventive Therapy for HIV-Infected Adults in Rio de Janeiro, Brazil

Dowdy

Golub

Saraceni³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The uptake of IPT in this study was lower than the global estimate (32.5 %), although there was no clear reason for this underutilization or under prescription [ 19 ]. Possible reasons may be the health care professionals’ skepticism about potential drug resistance [ 24 ] and subsequent underestimation of potential public health impact [ 46 ], as well as lack of adequate means to exclude a pre-existing TB infection prior to treatment initiation.…”

Section: Discussionmentioning

confidence: 99%

Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV: a retrospective cohort study

2015

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BackgroundIsoniazid preventive therapy (IPT) is a recommended strategy for prevention of tuberculosis (TB) in persons with Human Immunodeficiency Virus (HIV) although the benefits have not been unequivocally demonstrated in routine clinical practice with widespread ART adoption. Therefore, we assessed the effectiveness of IPT in prevention of TB or death in patients treated with antiretroviral therapy (ART) in a chronic care setting.MethodsRetrospective cohort study of HIV patients enrolled in chronic care from 2007 to 2013. Eligible participants were HIV infected subjects (age > 15 years) with no (history of) TB. The combined effect of IPT and ART on the composite outcome (TB or death) was estimated using time-dependent Cox regression with adjustment for baseline covariates.Results1,922 patients were included, 374 (19.4 %) received IPT and 258 (13.4 %) developed TB or deceased. The median follow-up duration of the cohort was 839 days, with a total of 5491 person years. In unadjusted analysis, the combination of IPT and ART lowered the hazard of TB or death by 65 % [HR = 0.35; 95 % CI (0.16, 0.77)] compared to ART alone. Even after adjustment for confounders, the combined effect of ART and IPT resulted in a 60 % hazard reduction of TB or death in comparison to participants who received ART without IPT [HR = 0.40; 95 % CI (0.18, 0.87)]. The IPT-specific benefit in patients not receiving ART could not be reliably estimated due to high rates of ART adoption.ConclusionThe combined effect of IPT and ART to prevent TB or death in HIV patients in a non-experimental setting in comparison to ART alone was estimated to be 60 %.

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“…C'est un peu pessimiste même dans une zone où les habitants vivent dans une très grande pauvreté comme le bidonville sud-africain de notreétude. La mortalité est 0,0064 par an dans [31], 0,0081 par an dans [29] et 0,0167 par an dans [56].…”

Section: Paramètres Démographiquesunclassified

“…On a pris pour la mortalité des personnes séropositives µ 2 = 0,1 par an comme dans [10] pour avoir une survie moyenne de 10 ans. Cette mortalitéétait 0,13 par an dans [31] et dans [29] (d'après uneétude en Ouganda [53]). Schulzer et al [59] ont supposé une durée fixe de survie de dix ans.…”

Section: Paramètres Du Vih Pour Les Personnes Non Infectées Par M Tuunclassified

“…En comparaison, le pourcentage de personnes séronégatives qui progressent rapidement vers une tuberculose activeétait de 5% dans [59] (la première année ; pas de référence), 5% dans [70] (après une courte période de latence d'environ un an ; pas de référence), 5% dans [29] (progression immédiate ; pas de référence), 5% par an dans [56] (risque constant ; pas de référence), 7% dans [20] (progression immédiate ; d'après [67]), 14% dans [10] (après une courte période de latence d'environ un an ; d'après [65] [65,68]). [20] suppose une réduction de 72% pour les personnes séronégatives et pour les personnes séropositives depuis peu (d'après [65]).…”

Section: Paramètres De La Tuberculose Pour Les Personnes Séronégativesunclassified

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Modeling the joint epidemics of TB and HIV in a South African township

et al. 2008

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We present a simple mathematical model with six compartments for the interaction between HIV and TB epidemics. Using data from a township near Cape Town, South Africa, where the prevalence of HIV is above 20% and where the TB notification rate is close to 2,000 per 100,000 per year, we estimate some of the model parameters and study how various control measures might change the course of these epidemics. Condom promotion, increased TB detection and TB preventive therapy have a clear positive effect. The impact of antiretroviral therapy on the incidence of HIV is unclear and depends on the extent to which it reduces sexual transmission. However, our analysis suggests that it will greatly reduce the TB notification rate.

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A re-examination of the potential impact of preventive therapy on the public health problem of tuberculosis in contemporary sub-Saharan Africa

Abstract: Background-To estimate the effect size of tuberculosis preventive therapy (PT) on the public health problem of tuberculosis in contemporary sub-Saharan Africa.

Cited by 9 publications

References 24 publications

Impact of Isoniazid Preventive Therapy for HIV-Infected Adults in Rio de Janeiro, Brazil

Impact of Isoniazid Preventive Therapy for HIV-Infected Adults in Rio de Janeiro, Brazil

Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV: a retrospective cohort study

Modeling the joint epidemics of TB and HIV in a South African township

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