Survey of isoniazid preventive therapy in South Africa, 2011

Jc, Chehab; K, Vilakazi-Nhlapo; Vranken, Peter; Peters, Annatjie; Jd, Klausner

doi:10.5588/ijtld.11.0722

Cited by 18 publications

(16 citation statements)

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“…IPT is typically initiated simultaneously with ART [44, 45]. We additionally considered the scenario where IPT was given to HIV-positive individuals for the entire duration of their lives, as has been recently recommended by the WHO [46].…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa

et al. 2016

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South Africa has one of the highest burdens of TB worldwide, driven by the country’s widespread prevalence of HIV, and further complicated by drug resistance. Active case finding within the community, particularly in rural areas where healthcare access is limited, can significantly improve diagnosis and treatment coverage in high-incidence settings. We evaluated the potential health and economic consequences of implementing community-based TB/HIV screening and linkage to care. Using a dynamic model of TB and HIV transmission over a time horizon of 10 years, we compared status quo TB/HIV control to community-based TB/HIV screening at frequencies of once every two years, one year, and six months. We also considered the impact of extending IPT from 36 months for TST positive and 12 months for TST negative or unknown patients (36/12) to lifetime use for all HIV-infected patients. We conducted a probabilistic sensitivity analysis to assess the effect of parameter uncertainty on the cost-effectiveness results. We identified four strategies that saved the most life years for a given outlay: status quo TB/HIV control with 36/12 months of IPT and TB/HIV screening strategies at frequencies of once every two years, one year, and six months with lifetime IPT. All of these strategies were very cost-effective at a threshold of $6,618 per life year saved (the per capita GDP of South Africa). Community-based TB/HIV screening with linkage to care is therefore very cost-effective in rural South Africa.

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Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa

et al. 2016

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“…We assumed that 50% of eligible infants with latent tuberculosis would be screened. Of those screened, 34% would be provided treatment [19]. Treatment had an efficacy of 78%, with a 20% probability of treatment completion [20].…”

Section: Methodsmentioning

confidence: 99%

Potential Cost-Effectiveness of a New Infant Tuberculosis Vaccine in South Africa - Implications for Clinical Trials: A Decision Analysis

Ditkowsky

Schwartzman

2014

PLoS ONE

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Novel tuberculosis vaccines are in varying stages of pre-clinical and clinical development. This study seeks to estimate the potential cost-effectiveness of a BCG booster vaccine, while accounting for costs of large-scale clinical trials, using the MVA85A vaccine as a case study for estimating potential costs. We conducted a decision analysis from the societal perspective, using a 10-year time frame and a 3% discount rate. We predicted active tuberculosis cases and tuberculosis-related costs for a hypothetical cohort of 960,763 South African newborns (total born in 2009). We compared neonatal vaccination with bacille Calmette-Guérin alone to vaccination with bacille Calmette-Guérin plus a booster vaccine at 4 months. We considered booster efficacy estimates ranging from 40% to 70%, relative to bacille Calmette-Guérin alone. We accounted for the costs of Phase III clinical trials. The booster vaccine was assumed to prevent progression to active tuberculosis after childhood infection, with protection decreasing linearly over 10 years. Trial costs were prorated to South Africa's global share of bacille Calmette-Guérin vaccination. Vaccination with bacille Calmette-Guérin alone resulted in estimated tuberculosis-related costs of $89.91 million 2012 USD, and 13,610 tuberculosis cases in the birth cohort, over the 10 years. Addition of the booster resulted in estimated cost savings of $7.69–$16.68 million USD, and 2,800–4,160 cases averted, for assumed efficacy values ranging from 40%–70%. A booster tuberculosis vaccine in infancy may result in net societal cost savings as well as fewer active tuberculosis cases, even if efficacy is relatively modest and large scale Phase III studies are required.

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“…Daily isoniazid for >6 months safely decreases active TB risk in HIV-positive patients by 60% (Akolo, Adetifa, Shepperd, & Volmink, 2010; Grant et al, 2010; van Halsema et al, 2010). South African guidelines recommend isoniazid preventive therapy (IPT) for all HIV-positive patients without active TB symptoms, regardless of CD4 count, antiretroviral therapy (ART) status or prior TB history ( Launch of 2013 Isoniazid Preventive Therapy Guidelines , 2013), yet completion rates are low (Chehab, Vilakazi-Nhlapo, Vranken, Peters, & Klausner, 2012). …”

Section: Introductionmentioning

confidence: 99%

“It’s about my life”: facilitators of and barriers to isoniazid preventive therapy completion among people living with HIV in rural South Africa

et al. 2017

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Despite the recent rollout of Isoniazid Preventive Therapy (IPT) to prevent TB in people living with HIV in South Africa, adherence and completion rates are low. To explore barriers to IPT completion in rural KwaZulu-Natal, South Africa, we conducted individual semi-structured interviews among 30 HIV patients who had completed or defaulted IPT. Interview transcripts were analyzed according to the framework method of qualitative analysis. Facilitators of IPT completion included knowledge of TB and IPT, accepting one’s HIV diagnosis, viewing IPT as similar to antiretroviral therapy, having social support in the community and the clinic, trust in the healthcare system, and desire for health preservation. Barriers included misunderstanding of IPT’s preventive role in the absence of symptoms, inefficient health service delivery, ineffective communication with healthcare workers, financial burden of transport to clinic and lost wages, and competing priorities. HIV-related stigma was not identified as a significant barrier to IPT completion, and participants felt confident in their ability to manage stigma, for example by pretending their medications were for unrelated conditions. Completers were more comfortable communicating with health care workers than were defaulters. Efforts to facilitate successful IPT completion must include appropriate counseling and education for individual patients and addressing inefficiencies within the health care system in order to minimize patients’ financial and logistical burden. These patient-level and structural changes are necessary for IPT to successfully reduce TB incidence in this resource-limited setting.

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Survey of isoniazid preventive therapy in South Africa, 2011

Abstract: IPT implementation in South Africa began in February 2011. The availability of IPT guidelines was strongly associated with IPT uptake. More operational studies are needed to improve IPT implementation among HIV-infected patients in South Africa.

Cited by 18 publications

References 0 publications

Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa

Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa

Potential Cost-Effectiveness of a New Infant Tuberculosis Vaccine in South Africa - Implications for Clinical Trials: A Decision Analysis

“It’s about my life”: facilitators of and barriers to isoniazid preventive therapy completion among people living with HIV in rural South Africa

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