Tuberculin skin test positivity among HIV-infected alcohol drinkers on antiretrovirals in south-western Uganda

Muyindike, Winnie; Fatch, Robin; Cheng, Debbie M.; Emenyonu, Nneka; Ngabirano, Christine; Adong, Julian; Linas, Benjamin P.; Jacobson, Karen R; Hahn, Judith A.

doi:10.1371/journal.pone.0235261

Cited by 9 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to our study findings, other studies found that proximity of contact to a TB index case was associated with an LTBI positivity [20,21]. In addition, our study showed that IGRA positivity was associated with increasing the time spent with the index TB patient which is…”

Section: Discussionsupporting

confidence: 91%

Integrating interferon-gamma release assay testing into provision of tuberculosis preventive therapy is feasible in a tuberculosis high burden resource-limited setting: A mixed methods study

Muchuro

Makabayi-Mugabe

Musaazi

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

The World Health Organization recommends the scale-up of tuberculosis preventive therapy (TPT) for persons at risk of developing active tuberculosis (TB) as a key component to end the global TB epidemic. We sought to determine the feasibility of integrating testing for latent TB infection (LTBI) using interferon-gamma release assays (IGRAs) into the provision of TPT in a resource-limited high TB burden setting. We conducted a parallel convergent mixed methods study at four tertiary referral hospitals. We abstracted details of patients with bacteriologically confirmed pulmonary tuberculosis (PBC TB). We line-listed household contacts (HHCs) of these patients and carried out home visits where we collected demographic data from HHCs, and tested them for both HIV and LTBI. We performed multi-level Poisson regression with robust standard errors to determine the associations between the presence of LTBI and characteristics of HHCs. Qualitative data was collected from health workers and analyzed using inductive thematic analysis. From February to December 2020 we identified 355 HHCs of 86 index TB patients. Among these HHCs, uptake for the IGRA test was 352/355 (99%) while acceptability was 337/352 (95.7%). Of the 352 HHCs that were tested with IGRA, the median age was 18 years (IQR 10–32), 191 (54%) were female and 11 (3%) were HIV positive. A total of 115/352 (32.7%) had a positive IGRA result. Among HHCs who tested negative on IGRA at the initial visit, 146 were retested after 9 months and 5 (3.4%) of these tested positive for LTBI. At multivariable analysis, being aged ≥ 45 years [PR 2.28 (95% CI 1.02, 5.08)], being employed as a casual labourer [PR 1.38 (95% CI 1.19, 1.61)], spending time with the index TB patient every day [PR 2.14 (95% CI 1.51, 3.04)], being a parent/sibling to the index TB patients [PR 1.39 (95% CI 1.21, 1.60)] and sharing the same room with the index TB patients [PR 1.98 (95% CI 1.52, 2.58)] were associated with LTBI. Implementation challenges included high levels of TB stigma and difficulties in following strict protocols for blood sample storage and transportation. Integrating home-based IGRA testing for LTBI into provision of TB preventive therapy in routine care settings was feasible and resulted in high uptake and acceptability of IGRA tests.

show abstract

Section: Discussionsupporting

confidence: 91%

Integrating interferon-gamma release assay testing into provision of tuberculosis preventive therapy is feasible in a tuberculosis high burden resource-limited setting: A mixed methods study

Muchuro

Makabayi-Mugabe

Musaazi

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…In sub-Saharan Africa (SSA), the prevalence of LTBI in the general population ranges from 31% to 55% [8][9][10] and was estimated at 28% in PWH in Uganda. 11 TB preventive therapy with INH is important for PWH and has been reported to decrease mortality by 30%-50% above and beyond the benefits of antiretroviral therapy (ART). [12][13][14][15][16] In addition, because TB is airborne, preventing TB in PWH also protects the families and community members of PWH.…”

Section: Introductionmentioning

confidence: 99%

Unhealthy Alcohol Use Is Associated With Suboptimal Adherence to Isoniazid Preventive Therapy in Persons With HIV in Southwestern Uganda

Muyindike

Fatch

Cheng

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Background: Unhealthy alcohol use is associated with increased progression to tuberculosis (TB) disease, but its effect on adherence to isoniazid (INH) preventive therapy is not known. Methods:This was a prospective study of persons with HIV with latent TB in southwestern Uganda reporting any current (previous 3 months) alcohol use or no alcohol consumption in the previous year (2:1 ratio). All received INH. We defined suboptimal adherence as ,90% of days with at least 1 Medication Event Monitoring System cap opening, over the previous 90 days. Alcohol use was categorized as follows: none: no self-report and phosphatidylethanol (PEth) ,8 ng/mL; moderate: Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) 1-2 (women) or 1-3 (men) and/or PEth 8 $ 50 ng/mL; and unhealthy: AUDIT-C $3 (women) or $4 (men) and/or PEth $50 ng/mL. We used generalized estimating equation logistic regression analyses to assess the association between the level of alcohol use and suboptimal INH adherence.Results: Three hundred two persons were enrolled; 279 were on INH for 3 or more months. The prevalence of suboptimal INH adherence was 31.3% at 3 months and 43.9% at 6 months. The odds of suboptimal INH adherence were higher for unhealthy (adjusted odds ratio, 2.78; 95% confidence interval: 1.62 to 4.76) and moderate (adjusted odds ratio, 1.59; 95% confidence interval: 0.94 to 2.71) compared with no alcohol consumption.Conclusions: Suboptimal adherence to INH at 3 and 6 months was high among prospective study of persons with HIV and associated with unhealthy alcohol use. Adherence support and alcohol reduction strategies are needed for this group at high risk for active TB.

show abstract

“…This study was limited in the fact that the sample was selected for the main study enrollment purposes (ie, having latent TB); this may limit the generalizability of the study. However, we did not observe any major differences between patients enrolled and those not enrolled when we analyzed major factors associated with one of the selection criteria (PPD+ skin test) [ 39 ]. Another limitation is that this study may have been underpowered to detect associations, as it was not designed to evaluate the relationships being examined.…”

Section: Discussionmentioning

confidence: 99%

Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study

Adong¹,

Fatch²,

Emenyonu³

et al. 2022

JMIR Form Res

Self Cite

View full text Add to dashboard Cite

Background HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone–delivered services for medical and public health practice. Objective Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). Methods We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use—a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ≥8 ng/mL. Results A total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages. Conclusions There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only.

show abstract

Tuberculin skin test positivity among HIV-infected alcohol drinkers on antiretrovirals in south-western Uganda

Cited by 9 publications

References 27 publications

Integrating interferon-gamma release assay testing into provision of tuberculosis preventive therapy is feasible in a tuberculosis high burden resource-limited setting: A mixed methods study

Integrating interferon-gamma release assay testing into provision of tuberculosis preventive therapy is feasible in a tuberculosis high burden resource-limited setting: A mixed methods study

Unhealthy Alcohol Use Is Associated With Suboptimal Adherence to Isoniazid Preventive Therapy in Persons With HIV in Southwestern Uganda

Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study

Contact Info

Product

Resources

About