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Isoniazid Tuberculosis Preventive Therapy in HIV-Infected Adults Accessing Antiretroviral Therapy: A Botswana Experience, 2004-2006

Mosimaneotsile, Barudi RN, MPH*; Mathoma, Anikie RN*; Chengeta, Bafanana RN, MSN*; Nyirenda, Samba MD*; Agizew, Tefera B MD, MPH*; Tedla, Zegabriel MD*; Motsamai, Oaitse I RN, MPH; Kilmarx, Peter H MD; Wells, Charles D MD§; Samandari, Taraz MD, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2010 - Volume 54 - Issue 1 - p 71-77
doi: 10.1097/QAI.0b013e3181c3cbf0
Epidemiology and Prevention

Objectives: To describe reasons for exclusion from isoniazid tuberculosis preventive therapy (IPT) and outcomes of persons living with HIV (PLWH) during 6 months of IPT.

Methods: In a clinical trial conducted in government clinics, first screening (screen 1) used National IPT Program guidelines and a second screening (screen 2) was trial specific. Adherence was defined as attending 6 monthly visits.

Results: Between 2004 and 2006, at 4018 screening visits, 2934 (73%) PLWH met screen 1 criteria; 1995 (68%) met screen 2 criteria and were enrolled. Major reasons for exclusion were illness (66%) at screen 1 and abnormal chest radiographs (36%) at screen 2. Tuberculin skin tests were ≥5 mm in 24% of those enrolled and 31% had CD4 lymphocyte counts <200 cells/mm3. During the 6 months, 8 (0.40%) developed tuberculosis disease, 28 (1.4%) had severe adverse events (19/28 were hepatitis including one death probably isoniazid-associated), 20 others died, and 22% initiated antiretroviral therapy (ART). Although adherence was 86%, being on ART improved adherence: relative risk 1.41 (95% confidence limits 1.04-1.91). In multivariate analysis, ART was associated with a 4.38 greater odds of adherence to IPT.

Conclusions: Six months of IPT was relatively safe and well-tolerated by PLWH. Adherence to IPT was significantly better among those receiving ART with IPT.

From the *BOTUSA, Gaborone and Francistown, Botswana; †Ministry of Health, National Tuberculosis Programme, Gaborone, Botswana; ‡Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention, Atlanta, GA; and §CDC, Division of Tuberculosis Elimination, Atlanta, GA.

Received for publication June 26, 2009; accepted September 30, 2009.

Correspondence to: Taraz Samandari, MD, PhD, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 6100 Clifton Road NE, MS E-10, Atlanta, GA 30333 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.