Abstract
SettingFour primary health care clinics providing tuberculosis (TB) and Human Immunodeficiency Virus care services in Bulawayo, Zimbabwe.ObjectivesTo assess isoniazid preventive therapy (IPT) initiation and completion, factors associated with IPT uptake and incidence of TB, and TB and antiretroviral treatment (ART) outcomes among people living with HIV (PLHIV).DesignThis was a cohort study using routine data in the records for PLHIV initiated on ART from October 2013 to March 2014 with 31 December 2017 as the end of the follow-up period.ResultsA total of 408 PLHIV were eligible for IPT, 214 (52%) were initiated on IPT and 201 (94%) completed IPT. No person in the IPT-initiated group developed Tuberculosis (TB). Six persons with TB were reported among the non-IPT-initiated group leading to an incidence of 9 cases/1,000 person-years of follow-up. About 70% of those who developed and were treated for TB had a successful TB treatment outcome. The survival on ART at four years of follow-up was 88% among the IPT-initiated PLHIV that was significantly higher than the 75% survival in the group not- initiated on IPT.ConclusionThe study revealed low IPT initiation among eligible PLHIV who, if started on IPT, completed the six month regimen. TB was reported only among the PLHIV not-initiated on IPT and the four year ART survival was higher in the IPT-initiated group than in the non-initiated group. These findings reinforce the need to strengthen IPT uptake among PLHIV in Bulawayo.
Highlights
In 2017, there were an estimated 37 million people living with HIV (PLHIV)
A total of 408 PLHIV were eligible for Isoniazid Preventive Therapy (IPT), 214 (52%) were initiated on IPT and 201 (94%) completed IPT
The survival on antiretroviral therapy (ART) at four years of follow-up was 88% among the IPT-initiated PLHIV that was significantly higher than the 75% survival in the group not- initiated on IPT
Summary
In 2017, there were an estimated 37 million people living with HIV (PLHIV). 22 million were on antiretroviral therapy (ART) [1]. There were an estimated 10 million incident cases of tuberculosis (TB). In PLHIV, TB is one of the major causes of morbidity and mortality accounting for approximately one in three AIDSrelated deaths [1]. PLHIV with TB infection have a 10% annual risk of developing TB compared to 10–20% lifetime risk in HIV non-infected individuals [2,3]. By providing Isoniazid Preventive Therapy (IPT) to PLHIV, the occurrence of TB can be reduced by up to 60% and TB-related death rates by approximately 40% [5]
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