title: Preventing tuberculosis among HIV-infected pregnant women in Lesotho: the case for rolling out active case finding and isoniazid preventive therapy.
abstract: BACKGROUND
  The Lesotho Ministry of Health issued guidelines on active case finding (ACF) for tuberculosis (TB) and isoniazid preventive therapy (IPT) in April 2011. ACF has been recommended in maternal and child health (MCH) settings globally, however, the feasibility of implementing IPT within MCH in countries with high concurrent HIV and TB epidemics is unknown.
  
  
  METHODS
  The study evaluated the implementation of ACF and IPT guidelines in MCH settings in 2 health facilities in Lesotho. This descriptive prospective study analyzed data collected during routine services. Categorical data and continuous variables were summarized using descriptive statistics. The χ test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively.
  
  
  RESULTS
  Data from 160 HIV-positive and 640 HIV-negative women were reviewed. Within this study population, 99.8% of women were screened for TB, and 11.4% HIV-positive women compared with 2.3% HIV-negative women were reported to have symptoms of TB (P < 0.001). IPT was initiated in 124/158 (78.5%) HIV-positive pregnant women, 64.5% women completed a 6-month IPT regimen, 2 (1.6%) died of causes unrelated to IPT/TB, and 31.5% were lost to follow-up. Predictors of IPT initiation among HIV-positive women included gestational age at the first antenatal visit (unadjusted odds ratio, -0.93; 95% confidence interval: -0.88 to 0.98), and receipt of antiretroviral therapy for treatment rather than for prevention of mother-to-child transmission prophylaxis only (odds ratio, 4.59; 95% confidence interval: 1.32 to 15.93).
  
  
  CONCLUSIONS
  Implementation of ACF and IPT is feasible within the MCH setting. Uptake of IPT during pregnancy among HIV-positive women was high, but with a high rate of loss to follow-up.
authors.affiliation: *Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho; †Stellenbosch University, Cape Town, South Africa; ‡New York Department of Health; §Ministry of Health Lesotho, Maseru, Lesotho; ‖Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD; ¶Elizabeth Glaser Pediatric AIDS Foundation Washington, DC; #Department of Epidemiology/Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC; and **Georgetown University, Washington, DC.
authors.forename: Appolinaire
authors.initials: A
authors.lastname: Tiam
authors.forename: Rhoderick
authors.initials: R
authors.lastname: Machekano
authors.forename: Celine R
authors.initials: CR
authors.lastname: Gounder
authors.forename: Llang B M
authors.initials: LB
authors.lastname: Maama-Maime
authors.forename: Keletso
authors.initials: K
authors.lastname: Ntene-Sealiete
authors.forename: Maitreyi
authors.initials: M
authors.lastname: Sahu
authors.forename: Anthony
authors.initials: A
authors.lastname: Isavwa
authors.forename: Oyebola
authors.initials: O
authors.lastname: Oyebanji
authors.forename: Allan
authors.initials: A
authors.lastname: Ahimbisibwe
authors.forename: Majoalane
authors.initials: M
authors.lastname: Mokone
authors.forename: Grace L
authors.initials: GL
authors.lastname: Barnes
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chaisson
authors.forename: Laura
authors.initials: L
authors.lastname: Guay
authors.forename: Seble
authors.initials: S
authors.lastname: Kassaye
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000382:microbiology* / Q000821:virology; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage*; D007927:Lesotho; D016015:Logistic Models; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology / Q000517:prevention & control* / Q000821:virology; D011295:Prenatal Care / Q000379:methods; D011446:Prospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control* / Q000821:virology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid