title: The implementation of isoniazid preventive therapy in HIV clinics: the experience from the TB/HIV in Rio (THRio) study.
abstract: OBJECTIVE
  The TB/HIV in Rio (THRio) study was launched in September 2005 to assess the impact of integrated tuberculosis (TB) and HIV treatment strategies in 29 HIV clinics in Rio de Janeiro, Brazil.
  
  
  METHODS
  THRio is a cluster-randomized trial (CRT) to determine whether routine screening for and treatment of latent TB in HIV clinic patients with access to antiretroviral therapy will reduce TB incidence at the clinic level. THRio is part of the Consortium to Respond Effectively to AIDS/TB Epidemic that is implementing research studies to assess the impact of bold, new public health paradigms for controlling the AIDS/TB epidemic.
  
  
  METHODS
  Twenty-nine public primary HIV clinics were randomly assigned a date to begin implementing TB screening procedures and provision of isoniazid preventive therapy (IPT) for TB/HIV coinfected patients. Final analysis of the CRT is expected in 2011.
  
  
  RESULTS
  Starting at date of tuberculin skin test (TST)/IPT implementation at each clinic through August 2010, 1670 HIV-infected patients initiated IPT, of which 215 are still receiving treatment. Of the remaining 1455 patients, 1230 (85%) completed therapy and only 20 (1.2%) patients initiating IPT reported adverse reactions leading to discontinuation of therapy. IPT completion was higher among HIV-infected patients receiving HAART (87%) than those not yet receiving HAART (79%, P < 0.01). Times to TST and IPT have markedly decreased postintervention, but remain considerably long. The richness of the THRio database has resulted in several analyses of this expansive cohort of HIV-infected patients that are reviewed here.
  
  
  CONCLUSIONS
  The national implementation of TST and IPT for HIV-positive patients in Brazil has been invigorated partly due to THRio's baseline results. Expanded use of IPT in HIV patients in Rio de Janeiro is achievable with high adherence and low adverse events, although this effort requires a package of activities including training, advocacy and reorganization of services.
authors.affiliation: Municipal Health Secretariat, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Betina
authors.initials: B
authors.lastname: Durovni
authors.forename: Solange C
authors.initials: SC
authors.lastname: Cavalcante
authors.forename: Valeria
authors.initials: V
authors.lastname: Saraceni
authors.forename: Vitoria
authors.initials: V
authors.lastname: Vellozo
authors.forename: Giselle
authors.initials: G
authors.lastname: Israel
authors.forename: Bonnie S
authors.initials: BS
authors.lastname: King
authors.forename: Silvia
authors.initials: S
authors.lastname: Cohn
authors.forename: Anne
authors.initials: A
authors.lastname: Efron
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Pacheco
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chaisson
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Golub
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D019562:Viral Load
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid