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      Isoniazid Preventive Therapy Uptake and Its Effect on Tuberculosis Incidence Among People Living with HIV in Illubabor and Buno Bedelle Zones, South-West Ethiopia, 2022: A Retrospective Cohort Study

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          Abstract

          Introduction

          Tuberculosis (TB) remains the leading cause of death among human immune deficiency virus (HIV) patients. Based on the 2020 global TB report, Ethiopia was among the 30 high TB and TB/HIV burden countries. This study filled gaps regarding IPT uptake in the study area and representative sample determination for assessing TB incidence and its predictors at public health facilities in Illubabor and Buno Bedelle zones, south-west Ethiopia.

          Methods

          This retrospective cohort study was conducted among people living with HIV (PLHIV) who were on antiretroviral therapy (ART) at public health facilities in Illubabor and Buno Bedelle zones, south-west Ethiopia. Both isoniazid preventive therapy (IPT) exposed and unexposed PLHIV were followed from the date of ART initiation until the date of TB diagnosis of the most recent visit prior to the end of follow-up. The Cox proportional hazard model was employed to identify variables that predicted the incidence of TB at a P value of <0.05.

          Results

          Data were collected on 421 PLHIV, with a response rate of 97.4%. The median (interquartile range (IQR)) age of the study participants was 32 (28–40) year. The incidence rate of pulmonary TB was 3.1 per 1000 person-months (95% CI: 2.4–3.9). The incidence rate of TB among IPT-exposed PLHIV was 1.45 per 1000 person-months, but it was 6.2 per 1000 person-months in the unexposed group. Patient’s residence, IPT exposure, baseline ART adherence, baseline hemoglobin level, baseline CD4+ cell, recent hemoglobin level, recent CD4+ cell, recent BMI, and recent WHO HIV clinical stage were independently associated with the incidence of TB.

          Conclusion

          Healthcare professionals working in ART clinics should routinely assess HIV-positive individuals for changes in clinical indicators and environmental exposures like living conditions, which will help HIV-positive individuals in reducing their risk for TB. Likewise, patients attending ART clinics should receive counseling on a regular basis.

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          Most cited references19

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          What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?

          Abstract Introduction Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population‐based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub‐Saharan Africa (SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90‐90‐90 campaign. Discussion These three‐year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community‐based testing approaches) achieved >90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient‐centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population‐level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub‐populations and were lower among youth. (3) UTT resulted in marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which mortality was comprehensively measured. Conclusions These trials provide strong evidence that UTT inclusive of universal testing increases population‐level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub‐country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.
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            Incidence and determinants of tuberculosis infection among adult patients with HIV attending HIV care in north-east Ethiopia: a retrospective cohort study

            Objective This study assessed the incidence of tuberculosis (TB) and its predictors among adults living with HIV/AIDS in government health facilities in north-east Ethiopia. Setting A 5-year retrospective cohort study was conducted from May to June 2015 on 451 adult HIV/AIDS-infected individuals who enrolled in the HIV care clinics of government health facilities in north-east Ethiopia. Participants A total of 451 HIV-infected adults who newly enrolled in the adult HIV care clinic from 1 July 2010 with complete information were followed until May 2015. Primary outcome measure The primary outcome was the proportion of patients diagnosed with TB or the TB incidence rate. Secondary outcome measure The incidence of TB was investigated in relation to years of follow-up. Results A total of 451 charts with complete information were followed for 1377.41 person-years (PY) of observation. The overall incidence density of TB was 8.6 per 100 PYof observation. Previous TB disease (adjusted HR (AHR) 3.65, 95% CI 1.97 to 6.73), being bedridden (AHR 5.45, 95% CI 1.16 to 25.49), being underweight (body mass index (BMI) <18.5 kg/m2) (AHR 2.53, 95 % CI 1.27 to 5.05), taking isoniazid preventive therapy (IPT) (AHR 0.14, 95% CI 0.05 to 0.39), haemoglobin below 11 g/dL (AHR 2.31, 95% CI 1.35 to 3.93), and being in WHO clinical stages III and IV (AHR 2.84, 95% CI 1.11 to 7.27; AHR 3.07, 95% CI 1.08 to 8.75, respectively) were significant for the incidence of TB. Conclusion The incidence of TB among adults living with HIV/AIDS in the first 3 years of follow-up was higher compared with that of subsequent years. Previous TB disease, no IPT, low BMI and haemoglobin level, advanced WHO clinical stage, and bedridden condition were the determinants of the incidence of TB. Therefore, addressing the significant predictors and improving TB/HIV collaborative activities should be strengthened in the study setting.
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              Effectiveness of isoniazid preventative therapy in reducing incidence of active tuberculosis among people living with HIV/AIDS in public health facilities of Addis Ababa, Ethiopia: a historical cohort study

              Background Human Immunodeficiency Virus (HIV) pandemic has exacerbated tuberculosis disease especially in Sub-Saharan African countries. The World Health Organization (WHO) and Joint United Nations Program on HIV/AIDS (UNAIDS) have recommended Isoniazid Preventive Therapy (IPT) for HIV infected patients to reduce the burden of tuberculosis (TB). Ethiopia has been implementing IPT since 2007. However, effectiveness of IPT in averting occurrence of active tuberculosis among HIV infected patients has not been assessed. Methods Retrospective cohort study was employed using secondary data from public health institutions of Addis Ababa. Descriptive statistics and Generalized Linear Model based on Poisson regression was used for data analysis. Results From 2524 HIV infected patients who were followed for 4106 Person-Years, a total of 277 incident Tuberculosis (TB) cases occurred. TB Incidence Rate was 0.21/100 Person-Year, 0.86/100 Person-Year & 7.18/100 Person-Year among IPT completed, in-completed and non-exposed patients, respectively. The adjusted Incidence Rate Ratio (aIRR) among IPT completed vs. non-exposed patients was 0.037 (95% CI, 0.016-0.072). Gender, residence area, employment status, baseline WHO stage of the disease (AIDS) and level of CD4 counts were identified as risk factors for TB incidence. The aIRR among patients who took Highly Active Anti- Retroviral Therapy (HAART) with IPT compared to those who took HAART alone was 0.063 (95% CI 0.035-0.104). IPT significantly reduced occurrence of active TB for 3 years. Conclusions IPT significantly reduced tuberculosis incidence by 96.3% compared to IPT non-exposed patients. Moreover concomitant use of HAART with IPT has shown a significant reduction in tuberculosis incidence by 93.7% than the use of HAART alone. Since IPT significantly protected occurrence of active TB for 3 years, its implementation should be further strengthened in the country.
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                Author and article information

                Journal
                HIV AIDS (Auckl)
                HIV AIDS (Auckl)
                hiv
                HIV/AIDS (Auckland, N.Z.)
                Dove
                1179-1373
                06 November 2023
                2023
                : 15
                : 649-662
                Affiliations
                [1 ]Department of Nursing, College of Health Science, Mattu University , Mattu, Ethiopia
                [2 ]Department of Anatomy, School of Medicine, Arba Minch University , Arba Minch, Ethiopia
                Author notes
                Correspondence: Maycas Gembe, Tel +251 936704900, Email MaycasDembelu27@gmail.com
                Author information
                http://orcid.org/0000-0002-6620-8547
                http://orcid.org/0000-0003-4651-9644
                http://orcid.org/0000-0002-7277-8490
                http://orcid.org/0000-0001-8836-4391
                http://orcid.org/0000-0001-8548-8671
                Article
                436787
                10.2147/HIV.S436787
                10637256
                2e0deac3-4fc6-4de3-af7d-c04a3c011836
                © 2023 Mulatu et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 23 August 2023
                : 31 October 2023
                Page count
                Figures: 4, Tables: 8, References: 25, Pages: 14
                Funding
                Funded by: received no funds for this work;
                We received no funds for this work.
                Categories
                Original Research

                Infectious disease & Microbiology
                tuberculosis,isoniazid preventive therapy,people living with hiv

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