Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

The effect of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected clients under pre-ART care, Jimma, Ethiopia: a retrospective cohort study

Authors: Lelisa Fekadu Assebe, Hailemariam Lemma Reda, Alem Desta Wubeneh, Wondwossen Terefe Lerebo, Saba Maria Lambert

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Tuberculosis (TB) is a major public health problem that accounts for almost half a million human immunodeficiency virus (HIV) associated deaths. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB in HIV infected individuals. However, in Ethiopia, the coverage and implementation of IPT is limited. The objective of this study is to compare the incidence rate of TB, TB-free survival time and identify factors associated with development TB among HIV-infected individuals on pre-ART follow up.

Methods

A retrospective cohort study was conducted from January, 2008 to February 31, 2012 in Jimma hospital. Kaplan-Meier survival plots were used to calculate the crude effect in both groups on TB-free survival probabilities and compared using the log rank test. A Cox proportional hazard model was used to identify predictors of TB.

Result

A total of 588 patients on pre-ART care (294 IPT and 294 non-IPT group) were followed retrospectively for a median duration of 24.1 months. The median CD4+ cell count was 422 cells/μl (IQR 344 – 589). During the follow up period, 49 individuals were diagnosed with tuberculosis, giving an overall incidence of 3.78 cases per 100 person year (PY). The incidence rate of TB was 5.06 per 100 PY in non-IPT group and 2.22 per 100 PY in IPT user group. Predictors of higher TB risk were: being on clinical WHO stage III/IV (adjusted hazard ratio (AHR = 3.05, 95% confidence interval (CI): 1.61, 5.81); non-IPT user (AHR = 2.02, 95% CI: 1.04, 3.92); having CD4+ cell count less than 350 cells/μl (AHR = 3.16, 95% CI: 1.04, 3.92) and between 350–499 cells/μl, (AHR = 2.87; 95% CI: 1.37 - 6.03) and having episode of opportunistic infection (OI) in the past (AHR = 2.41, 95% CI: 1.33-4.34).

Conclusion

IPT use was associated with fifty percent reduction in new cases of tuberculosis and probability of developing TB was higher in non-IPT group. Implementing the widespread use of IPT has the potential to reduce TB rates substantially among HIV-infected individuals in addition to other tuberculosis prevention and control effort in resource limited settings.
Literature
1.
WHO. Global Tuberculosis Control Report Geneva. 2007.
2.
Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G. Tuberculosis and HIV Co-Infection. PLoS Pathog. 2012;8(2):e1002464. doi:10.1371/journal.ppat.1002464.CrossRefPubMedPubMedCentral
3.
Guimarães RM, Lobo AP, Siqueira EA, Borges TFF, Melo SCC. Tuberculosis, HIV, and poverty: temporal trends in Brazil, the Americas, and worldwide. J Bras Pneumol. 2012;38(4):511–7.CrossRefPubMed
4.
Christopher D, Brian G. The population dynamics and control of tuberculosis. Science. 2010;328:856–61.CrossRef
5.
WHO. Guidelines for intensified tuberculosis case finding and Isoniazid preventive therapy for people living with HIV in resource constrained settings. Geneva: Switzerland; 2011.
6.
7.
8.
Asegid W, Almaz A, Frehywot E, Beniam F, Jelaludin A, Ashenafi H, et al. Findings of the pilot sentinel TB/HIV surveillance system in Ethiopia. Ethiopian Health and Nutrition Research Institute (EHNRI). 2010. report.
9.
Amenu Wesen Denegetu AW, Dolamo BL. Tuberculosis case finding and isoniazid preventive therapy among people living with HIV at public health facilities of Addis Ababa, Ethiopia: a cross-sectional facility based study. BMC Public Health. 2014;14:52.CrossRefPubMedPubMedCentral
10.
World Health Organization. United Nations Children’s Fund, UNAIDS, scaling up priority HIV/AIDS interventions in the health sector Progress report, Geneva, Switzerland 2009.
11.
Kibret KT, Yalew AW, Belaineh BG, Asres MM. Determinant Factors Associated with Occurrence of Tuberculosis among Adult People Living with HIV after Antiretroviral Treatment Initiation in Addis Ababa, Ethiopia: A Case Control Study. PLoS One. 2013;8(5):e64488. doi:10.1371/journal.pone.0064488.CrossRefPubMedPubMedCentral
12.
Egger M, May M, Chene G, Phillips AN, Ledergerber B, Dabis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360:119–29.CrossRefPubMed
13.
Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD000171. doi:10.1002/14651858.CD000171.pub3.
14.
Lawn SD, Badri M, Wood R. Tuberculosis among HIV–infected patients receiving HAART: long term incidence and risk factors in a South African cohort. AIDS. 2005;19(18):2109–16.CrossRefPubMed
15.
Golub JE, Pronyk P, Mohapi L, Thsabangu N, Moshabela M, Struthers H, et al. Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort. AIDS. 2009;23(5):631–6.CrossRefPubMedPubMedCentral
16.
Pinho AM, Santoro-Lopes G, Harrison L, Schechter M. Chemoprophylaxis for tuberculosis and survival of HIV-infected patients in Brazil. AIDS. 2001;15:2129–35.CrossRefPubMed
17.
Yirdaw KD, Jerene D, Gashu Z, Edginton ME, Kumar AMV, et al. Beneficial Effect of Isoniazid Preventive Therapy and Antiretroviral Therapy on the Incidence of Tuberculosis in People Living with HIV in Ethiopia. PLoS One. 2014;9(8):e104557.CrossRefPubMedPubMedCentral
18.
Getahun H, Granich R, Sculier D, Gunneberg C, Blanc L, Nunn P, et al. Implementation of isoniazid preventive therapy for people living with HIV worldwide: barriers and solutions. AIDS. 2010;24 suppl 5:S57–65.CrossRefPubMed
19.
Wilkinson D, Squire BS, Garner P. Effect of preventive treatment for tuberculosis in adults infected with HIV: systematic review of randomized placebo controlled trials. BMJ. 1998;317:625–9.CrossRefPubMedPubMedCentral
20.
Grant AD, Charalambous S, Fielding KL, Day JH, Corbett EL, Chaisson RE, et al. Effect of Routine Isoniazid Preventive Therapy on Tuberculosis Incidence among HIV-Infected Men in South Africa. A Novel Randomized Incremental Recruitment Study. JAMA. 2005;293(22):2719–25.CrossRefPubMed
21.
Teferi T, Iyaloo J, Kalibbala M, Makai M, Hango JN, Nkongolo OT, et al. Effect of primary isoniazid preventive therapy on tuberculosis incidence rate among HIV-infected adults enrolled in HIV care in northern Namibia 2012: a retrospective cohort study. AIDS 2012, Abstract no. WEPE066-Poster Exhibition. Available from: URL: http://​pag.​aids2012.​org/​Abstracts.​aspx?​AID=​7130 accessed Feb 06, 2013.
22.
Golub JE, Saraceni V, Cavalcante SC, Pacheco AG, Moulton LH, et al. The impact of anti-retroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS. 2007;21(11):1441–8.CrossRefPubMedPubMedCentral
23.
Kabali C, von Reyn CF, Brooks DR, Waddell R, Mtei L, Bakari M, et al. Completion of isoniazid preventive therapy and survival in HIV-infected, TST-positive adults in Tanzania. Int J Tuberc Lung Dis. 2011;15(11):1515–21.CrossRefPubMed
24.
Hawken MP, Meme HK, Elliott LC, Chakaya JM, Morris JS, Githui WA, et al. Isoniazid preventive therapy for tuberculosis in HIV-1-infected adults: results of a randomized controlled trial. AIDS. 1997;11:875–82.CrossRefPubMed
25.
Kassa A, Jerene D, Assefa Y, Teka A, Aseffa A, Deribew A. Evaluation of collaborative TB/HIV activities in a general hospital in Addis Ababa, Ethiopia. BMC Res Notes. 2012;5:67.CrossRefPubMedPubMedCentral
26.
Braun M, Wiesner P. Tuberculosis Prevention Practices and Perspectives of Physicians in DeKalb County. Public Health Rep. 1994;109(2):259–65.PubMedPubMedCentral
27.
Pape JW, Jean SS, Ho JL. Effect of isoniazid prophylaxis on the incidence of active tuberculosis and progression of HIV infection. Lancet. 1993;342:268–72.CrossRefPubMed
28.
Hosmer DW, Lemeshow S. Applied Survival Analysis. New York: John Wiley and Sons, Inc.; 1999.
29.
Quigley MA, Mwinga A, Hosp M, Lisse I, Fuchs D, Porter T. Long-term effect of preventive therapy for tuberculosis in a cohort of HIV infected Zambian adults. AIDS. 2001;15:215–22.CrossRefPubMed
30.
Khawcharoenporn T, Apisarnthanarak Manosuthi W, Sungkanuparph S, Mundy L. Isoniazid Preventive Therapy and Incidence of Pulmonary Tuberculosis among HIV-infected Patients on Antiretroviral Therapy: A 4-year Study. Int J Tuberc Lung Dis. 2012;16(3):336–41.CrossRefPubMed
31.
Casado J, Moreno S, Fortu J, Antela A, Quereda C, Navas E, et al. Risk Factors for Development of Tuberculosis after Isoniazid Chemoprophylaxis in Human Immunodeficiency Virus–Infected Patients. Clin Infect Dis. 2002;34:386–9.CrossRefPubMed
32.
Samandari T, Agizew TB, Nyirenda S, Tedla Z, Sibanda T, Shang N, et al. 6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomized, double-blind, placebo-controlled trial. Lancet. 2011;377(9777):1588–98.CrossRefPubMed
33.
Churchyard G, Scano F, Grant A, Chaisson R. Tuberculosis Preventive Therapy in the Era of HIV Infection: Overview and Research Priorities. J Infect Dis. 2007;196:S52–62.CrossRefPubMed
34.
Whalen CC, Johnson J, Okwera A, Hom D, Huebner R, Mugyenyi P. A trial of three regimens to prevent tuberculosis in Ugandan adults infected with the human immunodeficiency virus. N Engl J Med. 1997;337:801–8.CrossRefPubMed
Metadata
Title
The effect of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected clients under pre-ART care, Jimma, Ethiopia: a retrospective cohort study
Authors
Lelisa Fekadu Assebe
Hailemariam Lemma Reda
Alem Desta Wubeneh
Wondwossen Terefe Lerebo
Saba Maria Lambert
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1719-0

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

App use, physical activity and healthy lifestyle: a cross sectional study

Research article

Epidemiology of infections by HIV, Syphilis, Gonorrhea and Lymphogranuloma Venereum in Barcelona City: a population-based incidence study

Research article

Social inequalities in a population based colorectal cancer screening programme in the Basque Country

Research article

Socioeconomic status and environmental noise exposure in Montreal, Canada

Research article

Comparison of IgG against plastic resin in workers with and without chemical dermatitis

Research article

The current status of malaria epidemiology in Bolifamba, atypical Cameroonian rainforest zone: an assessment of intervention strategies and seasonal variations