The study focuses on isoniazid preventive therapy, or simply isoniazid, a lifesaving treatment used among people living with HIV (PLHIV) to prevent TB
By Corey White (Research for Evidence)
A new PLOS ONE article on tuberculosis (TB) co-authored by an FHI 360 colleague in Ethiopia recently caught my attention because of its global health implications. The article focuses on isoniazid preventive therapy – IPT or simply isoniazid, a lifesaving treatment used among people living with HIV (PLHIV) to prevent TB. Isoniazid is especially helpful at preventing TB after the initiation of HIV antiretroviral therapy which is a period when TB risk is high (Yirdaw, et al., 2014). Since TB is the deadliest infection for PLHIV (WHO, 2018), WHO recommends taking isoniazid during this initiation period (WHO, 2011). Isoniazid lowers the risk of mortality, treats latent (non-symptomatic) TB infections, and slows the progression of TB in PLHIV (Golub, et al., 2009; Volmink and Woldehanna, 2004).
Sometimes PLHIV still develop TB while taking isoniazid, which is defined as “breakthrough TB”. Studies that determine how common breakthrough TB among PLHIV actually is and what factors influence its development can better inform health care providers and policy makers as well as provide additional evidence to support test-and-treat strategies. In this post, I summarize how the new PLOS ONE article accomplishes both.
Together with researchers from Addis Ababa University, MERQ Consultancy and the Gates Foundation, FHI 360’s Kesetebirhan Delele Yirdaw conducted a retrospective longitudinal study spanning 2005 through 2014 to calculate the magnitude of breakthrough TB (and use of isoniazid) and assess the factors associated with its development. The team analyzed data from existing records of all newly enrolled patients (n = 35,789) in HIV care across 11 randomly identified government hospitals in three different regions in Ethiopia.
Calculating the magnitude of breakthrough TB
Yirdaw, et al. first calculate the uptake of isoniazid. Overall, the global uptake of isoniazid among PLHIV has been slow but there has been progress – growing from 5 percent coverage in 2013 (WHO, 2014) to 52 percent in 2016 (WHO, 2017).
Using MS Access to clean and store data and STATA to analyze it, the authors find 4,484 of the 35,789 PLHIV received isoniazid. That’s only 12.5 percent in this study area.
Read the complete story at Research for Evidence