scholarly journals The effectiveness of prevention and early detection of tuberculosis in people living with HIV

2020 ◽  
Author(s):  
Mikhail Sinitsyn ◽  
Evgeniy Belilovsky ◽  
Elena Bogorodskaya ◽  
Sergey Borisov ◽  
Dmitry Kudlay ◽  
...  
Keyword(s):  
Early Detection ◽  
Skin Testing ◽  
Latent Tuberculosis ◽  
Preventive Therapy ◽  
Tuberculosis Infection ◽  
People Living With Hiv ◽  
Notification Rate ◽  
Hiv Patients ◽  
Living With Hiv ◽  
Full Design

AbstractBackgroundThe difficult epidemic situation caused by TB/HIV co-infection and, accordingly, the need to strengthen measures for the prevention of tuberculosis among HIV patients, identified the need to create a model of collaborating tuberculosis management facilities and AIDS centers.Study purposeanalysis of the effectiveness of measures used in Moscow to prevent the spread of HIV/tuberculosis co-infection based on the developed new algorithm.Materials and methodsThe design of the study – a full-design retrospective cohort study of all HIV patients in tuberculosis preventive care and early detection unit for HIV patients (PCED TB Unit), which was organized in 2014 as a subdivision of Moscow TB Center on the premises of the Moscow AIDS Center. The study was conducted from 2014 to 2017. 22,190 HIV-infected patients were examined. In order to detect tuberculosis infection, all HIV patients were referred for skin testing with preparation Diaskintest, which represents recombinant proteins CFP10-ESAT6 and persons with a positive and doubtful reaction were examined for the diagnosis of tuberculosis and latent tuberculosis infection (LTBI). Preventive therapy (PT) was prescribed to patients with LTBI, which was also received by those with CD4+count ≤350 cells/mm3, regardless of the results of a skin test.ResultsOver a period of 4 years, Diaskintest was performed in 19,777 people. Positive results were in 857 patients (4.3%) [95% CI 4.1-4.6]. 131 patients were diagnosed with tuberculosis, the rest - with LTBI. The effectiveness of PT was estimated by the number of TB cases detected among HIV patients who completed PT (1757) and those who did not receive it (5990). The notification rate of TB in the first group was 228 [95%CI 65-582] per 100,000 patients, in the second 1486 [95%CI 1195–1825], which is 6,5 times higher. To assess the effectiveness of early detection of TB, the proportion of severity forms of pulmonary TB diagnosed in 87 patients at the PCED TB Unit using a new algorithm in 2016-2017 were compared with 411patients detected in different medical organizations of Moscow using conventional methods. The proportion of disseminated TB was lower in the first group (23.0% versus 44.5%) (p<0.01).ConclusionThe study showed that the integration of the two services allows increases the accessibility of TB care and makes a significant contribution to improving the effectiveness of measures to prevent the TB spread among HIV patients. It supports the necessity of treating LTBI detected using the Diaskintest to prevent TB in HIV-infected patients. Significant effects that have been achieved include a reduction in the TB notification rate among HIV patients, improvement of the diagnostic structure of registered TB cases as a result of their timely detection.

scholarly journals Determinants of losses in the latent tuberculosis infection cascade of care in Brazil

2021 ◽  
Vol 6 (9) ◽  
pp. e005969
Author(s):  
Alexandra Brito Souza ◽  
María B Arriaga ◽  
Gustavo Amorim ◽  
Mariana Araújo-Pereira ◽  
Betânia M F Nogueira ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Clinical Investigation ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Radiographic Examination ◽  
Interferon Gamma Release Assay ◽  
People Living With Hiv ◽  
Cascade Of Care ◽  
Living With Hiv ◽  
Close Contacts

IntroductionFactors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil.MethodsClose contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6–24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade.ResultsAmong 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/pardo (brown) race were independently associated with losses in the cascade.ConclusionThere were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.

scholarly journals Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries

2015 ◽  
Vol 46 (6) ◽  
pp. 1563-1576 ◽  
Author(s):  
Haileyesus Getahun ◽  
Alberto Matteelli ◽  
Ibrahim Abubakar ◽  
Mohamed Abdel Aziz ◽  
Annabel Baddeley ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Skin Testing ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
World Health ◽  
Public Health Approach ◽  
People Living With Hiv ◽  
Tuberculin Skin Testing ◽  
Mycobacterium Tuberculosis Infection ◽  
Systematic Testing

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3–4 month isoniazid plus rifampicin; or 3–4 month rifampicin alone.

scholarly journals Determinants of losses in the latent tuberculosis infection cascade of care in Brazil: a prospective multicenter cohort study

2021 ◽  
Author(s):  
Alexandra Brito Souza ◽  
María B. Arriaga ◽  
Gustavo Amorim ◽  
Mariana Araújo-Pereira ◽  
Betânia M. F. Nogueira ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Radiographic Examination ◽  
Interferon Gamma Release Assay ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Cascade Of Care ◽  
Living With Hiv ◽  
Close Contacts

ABSTRACTBackgroundFactors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of tuberculosis (TB) patients were investigated in a multicenter prospective cohort from highly endemic regions in Brazil.MethodsClose contacts of 1,187 culture-confirmed pulmonary TB patients were prospectively studied between 2015 and 2019, with follow-up between 6 and 24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Stepwise multivariable models were used to identify determinants of losses in the LTBI cascade.ResultsAmong 4,145 TB contacts initially identified, 1,901 were examined (54% loss). Within those individuals, 933 were people living with HIV, ≤5 years-old and/or had positive IGRA results, therefore having recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (6% of all TB contacts) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy, and black/pardo (brown) race were independently associated with losses in cascade.ConclusionThere were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts who are socially vulnerable and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.40-word summary of the article’s main pointWe investigated factors associated with losses in the latent tuberculosis infection cascade of care in a large cohort of contacts in Brazil. Social vulnerability and HIV infection were the most relevant determinants of losses in the LTBI cascade of care.

scholarly journals Continuous isoniazid for the treatment of latent tuberculosis infection in people living with HIV

AIDS ◽  
2016 ◽  
Vol 30 (5) ◽  
pp. 797-801 ◽  
Author(s):  
Saskia Den Boon ◽  
Alberto Matteelli ◽  
Nathan Ford ◽  
Haileyesus Getahun
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals Isoniazid Preventive Therapy Adherence and Associated Factors among HIV Positive Patients in Addis Ababa, Ethiopia

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Melaku Berhe ◽  
Meaza Demissie ◽  
Gezahegn Tesfaye
Keyword(s):  
Associated Factors ◽  
Addis Ababa ◽  
Latent Tuberculosis ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Health Centers ◽  
Isoniazid Preventive Therapy ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Living With Hiv

Tuberculosis coinfected with HIV constitutes a large proportion of patients in Ethiopia. Isoniazid preventive therapy (IPT) is recommended for the treatment of latent tuberculosis infection. However, the level of IPT adherence and associated factors among people living with HIV (PLHIV) have not been well explored. This study aimed to assess adherence to IPT and associated factors among PLHIV in Addis Ababa. Facility based cross-sectional study was conducted. The study was conducted in 10 health centers and 2 hospitals. Patients were consecutively recruited till the required sample size was obtained. From 406 PLHIV approached, a total of 381 patients on IPT were interviewed. Data were entered and analyzed using Epi-Info version 3.5 and SPSS version 16. The level of adherence to IPT was 89.5%. Patients who have taken isoniazid for ≥5 months were more likely to be adherent than those who took it for 1-2 months [AOR (95%CI) = 5.09 (1.41–18.36)]. Patients whose friends decide for them to start IPT were less likely to be adherent than others [AOR (95%CI) = 0.10 (0.01–0.82)]. The level of adherence to IPT in PLHIV was high. Counseling of patients who are in their first two months of therapy should be more strengthened. Strong Information Education Communication is essential to further enhance adherence.

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