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Brief Report

High Programmatic Isoniazid Preventive Therapy (IPT) Use in Pregnancy Among HIV-Infected Women

LaCourse, Sylvia M. MD, MPHa; Wagner, Anjuli D. MPH, PhDb; Cranmer, Lisa M. MD, MPHc,d; Copeland, Audrey BSN, BSe,f; Maleche-Obimbo, Elizabeth MBChB, MMed, MPH, FPulmg; Richardson, Barbra A. PhDb,h; Matemo, Daniel MPHi; Kinuthia, John MBChB, MMed, MPHi,j; John-Stewart, Grace MD, PhDa,b,k,l

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1, 2019 - Volume 82 - Issue 1 - p 41–45
doi: 10.1097/QAI.0000000000002086
Clinical Science
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Background: The World Health Organization recommends isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) to prevent tuberculosis (TB), including pregnant women. Recent trial results suggest increased adverse pregnancy outcomes associated with IPT during pregnancy. Data are limited regarding programmatic IPT use in pregnant PLHIV.

Methods: We assessed previous programmatic IPT during pregnancy among HIV-infected mothers on enrollment to an infant TB prevention trial in Kenya. Pregnancy IPT use was assessed by the estimated conception date assuming 38 weeks of gestation. Correlates of initiation and completion were analyzed by relative risk regression, using generalized linear models with log link and Poisson family adjusted for IPT initiation year.

Results: Between August 15, 2016, to June 6, 2018, 300 HIV-infected women enrolled at 6 weeks postpartum. Two hundred twenty-four (74.7%) women reported previous IPT, of whom 155/224 (69.2%) had any pregnancy IPT use. Forty-five (29.0%) initiated preconception extending into early pregnancy, 41 (26.5%) initiated and completed during pregnancy, and 69 (44.5%) initiated in pregnancy and extended into early postpartum. The median gestational age at IPT pregnancy initiation was 15.1 weeks (interquartile range 8.3–28.4). Pregnancy/early postpartum IPT initiation was associated with new pregnancy HIV diagnosis [adjusted relative risk 1.9 95% confidence interval (CI): 1.6 to 2.2, P < 0.001]. Six-month IPT completion rates were high [147/160 (91.9%)] among women with sufficient time to complete before trial enrollment and similar among preconception or during pregnancy initiators [adjusted relative risk 0.93 (95% confidence interval: 0.83 to 1.04, P = 0.19)].

Conclusions: Programmatic IPT use was high in pregnant PLHIV, with frequent periconception and early pregnancy initiation. Programmatic surveillance could provide further insights on pregnancy IPT implementation and maternal and infant safety outcomes.

aDepartment of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA;

bGlobal Health, University of Washington, Seattle, WA;

cDepartment of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA;

dChildren's Healthcare of Atlanta, Atlanta, GA;

eSchools of Nursing, Emory University, Atlanta, GA;

fPublic Health, Emory University, Atlanta, GA;

gDepartment of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya;

hDepartment of Biostatistics, University of Washington, Seattle, WA;

iDepartment of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya;

jReproductive Health, Kenyatta National Hospital, Nairobi, Kenya; and

Departments of kEpidemiology;

lPediatrics, University of Washington, Seattle, WA.

Correspondence to: Sylvia M. LaCourse, MD, MPH, Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, 325 9th Avenue, Box 359931, Seattle, WA 98104 (e-mail: sylvial2@uw.edu).

Supported by the Thrasher Research Fund, National Institute of Allergy and Infectious Diseases (NIAID), and National Center for Advancing Translational Sciences at National Institutes of Health (NIH) (Thrasher to G.J.-S., K23 AI 120793-03 to S.M.L., and UL1TR000423 for REDCap).

Contents of this article are solely the responsibility of the authors and do not necessarily represent official views of the funders. Funding sources were not involved in analyses or interpretation of the data.

The authors have no additional conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received January 15, 2019

Accepted April 15, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.