title: Beneficial effect of isoniazid preventive therapy and antiretroviral therapy on the incidence of tuberculosis in people living with HIV in Ethiopia.
abstract: BACKGROUND
  IPT with or without concomitant administration of ART is a proven intervention to prevent tuberculosis among PLHIV. However, there are few data on the routine implementation of this intervention and its effectiveness in settings with limited resources.
  
  
  OBJECTIVE
  To measure the level of uptake and effectiveness of IPT in reducing tuberculosis incidence in a cohort of PLHIV enrolled into HIV care between 2007 and 2010 in five hospitals in southern Ethiopia.
  
  
  METHODS
  A retrospective cohort analysis of electronic patient database was done. The independent effects of no intervention, "IPT-only," "IPT-before-ART," "IPT-and-ART started simultaneously," "ART-only," and "IPT-after-ART" on TB incidence were measured. Cox-proportional hazards regression was used to assess association of treatment categories with TB incidence.
  
  
  RESULTS
  Of 7,097 patients, 867 were excluded because they were transferred-in; a further 823 (12%) were excluded from the study because they were either identified to have TB through screening (292 patients) or were on TB treatment (531). Among the remaining 5,407 patients observed, IPT had been initiated for 39% of eligible patients. Children, male sex, advanced disease, and those in Pre-ART were less likely to be initiated on IPT. The overall TB incidence was 2.6 per 100 person-years. As compared to those with no intervention, use of "IPT-only" (aHR = 0.36, 95% CI = 0.19-0.66) and "ART-only" (aHR = 0.32, 95% CI = 0.24-0.43) were associated with significant reduction in TB incidence rate. Combining ART and IPT had a more profound effect. Starting IPT-before-ART (aHR = 0.18, 95% CI = 0.08-0.42) or simultaneously with ART (aHR = 0.20, 95% CI = 0.10-0.42) provided further reduction of TB at ∼ 80%.
  
  
  CONCLUSIONS
  IPT was found to be effective in reducing TB incidence, independently and with concomitant ART, under programme conditions in resource-limited settings. The level of IPT provision and effectiveness in reducing TB was encouraging in the study setting. Scaling up and strengthening IPT service in addition to ART can have beneficial effect in reducing TB burden among PLHIV in settings with high TB/HIV burden.
authors.affiliation: Clinical Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia.
authors.forename: Kesetebirhan Delele
authors.initials: KD
authors.lastname: Yirdaw
authors.affiliation: Clinical Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia.
authors.forename: Degu
authors.initials: D
authors.lastname: Jerene
authors.affiliation: Clinical Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia.
authors.forename: Zewdu
authors.initials: Z
authors.lastname: Gashu
authors.affiliation: Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris, France.
authors.forename: M E
authors.initials: ME
authors.lastname: Edginton
authors.affiliation: International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: Health Research and Technology Transfer Support Process, Southern Nations Nationalities and People's Region Health Bureau, Hawassa, Southern Nations Nationalities and People's Region, Ethiopia.
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Letamo
authors.affiliation: Care and treatment branch, TB/HIV unit, Centers for Disease Control and Prevention, Addis Ababa, Ethiopia.
authors.forename: Beniam
authors.initials: B
authors.lastname: Feleke
authors.affiliation: PCM Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia.
authors.forename: Alula M
authors.initials: AM
authors.lastname: Teklu
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Solomon
authors.initials: S
authors.lastname: Zewdu
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Bill
authors.initials: B
authors.lastname: Weiss
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D007538:Isoniazid
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