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Preventing Tuberculosis Among HIV-Infected Pregnant Women in Lesotho: The Case for Rolling Out Active Case Finding and Isoniazid Preventive Therapy

Tiam, Appolinaire MBChB, MMed*; Machekano, Rhoderick PhD, MPH; Gounder, Celine R. MD, ScM; Maama-Maime, Llang B.M. MD, MIPH§; Ntene-Sealiete, Keletso BPharm§; Sahu, Maitreyi MSPH; Isavwa, Anthony MSc*; Oyebanji, Oyebola MBChB, MPH*; Ahimbisibwe, Allan MBChB, MPH*; Mokone, Majoalane BSN*; Barnes, Grace L. BSN, MPH; Chaisson, Richard E. MD; Guay, Laura MD¶,#; Kassaye, Seble MD, MS**

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1st, 2014 - Volume 67 - Issue 1 - p e5–e11
doi: 10.1097/QAI.0000000000000209
Implementation and Operational Research: Epidemiology and Prevention

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.

Design/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 χ2 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.

*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.

Correspondence to: Appolinaire Tiam, MBChB, MMed, Elizabeth Glaser Pediatric AIDS Foundation, First Floor Sechaba House, 4, Bowker Road, Maseru 100, Lesotho (e-mail:

Supported by funds from the Bill and Melinda Gates Foundation through an award to the Johns Hopkins University, and the Elizabeth Glaser Pediatric AIDS Foundation.

Parts of the data were presented at the 43rd Union World Conference on Lung Health, and Abstract Oral Presentation OP-157-16, November 13–17, 2012, Kuala Lumpur, Malaysia.

The authors have no conflicts of interest to disclose.

A.T. designed the study, analyzed the data, and wrote the article. S.K. contributed to the design and analysis, and helped with the editing. R.M. analyzed the data and contributed to editing. C.R.G., L.B.M.M., K.N-S, M.S., O.O., A.A., G.L.B., R.E.C., and L.G. contributed to study design and editing of article.

Received May 05, 2014

Accepted May 05, 2014

© 2014 by Lippincott Williams & Wilkins