Community-based referral for tuberculosis preventive therapy is effective for treatment completion.

Autor:	Shenoi SV; Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America.; Yale Institute of Global Health, New Haven, Connecticut, United States of America., Kyriakides TC; Yale School of Public Health, Biostatistics, Yale Center for Analytical Sciences, New Haven, Connecticut, United States of America., Dokubo EK; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America., Guddera V; Philanjalo NGO, Tugela Ferry, South Africa.; South African Medical Research Council, Durban, South Africa., Vranken P; U.S. Centers for Disease Control and Prevention, Pretoria, South Africa., Desai M; Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America., Friedland G; Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America.; Yale Institute of Global Health, New Haven, Connecticut, United States of America., Moll AP; Philanjalo NGO, Tugela Ferry, South Africa.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 Dec 14; Vol. 2 (12), pp. e0001269. Date of Electronic Publication: 2022 Dec 14 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0001269
Abstrakt:	Expansion of tuberculous preventive therapy (TPT) is essential to curb TB incidence and mortality among people with HIV (PWH), yet implementation has been slow. Innovative strategies to operationalize TPT are urgently needed. Here we present an evaluation of community-based identification and referral of PWH on completion of a six-month course of isoniazid in a highly prevalent region in rural South Africa. Using a community-based TB/HIV intensive case finding strategy, a team of nurses and lay workers identified community members with HIV who were without fever, night sweats, weight loss, or cough and referred them to the government primary care clinics for daily oral isoniazid, the only available TPT regimen. We measured monthly adherence and six-month treatment completion in the community-based identification and referral (CBR) group compared to those already engaged in HIV care. Adherence was measured by self-report and urine isoniazid metabolite testing. A multivariable analysis was performed to identify independent predictors of TPT completion. Among 240 participants, 81.7% were female, median age 35 years (IQR 30-44), and 24.6% had previously been treated for TB. The median CD4 count in the CBR group was 457 (IQR 301-648), significantly higher than the clinic-based comparison group median CD4 of 344 (IQR 186-495, p<0.001). Independent predictors of treatment completion included being a woman (aOR 2.41, 95% 1.02-5.72) and community-based identification and referral for TPT (aOR 2.495, 95% 1.13-5.53). Among the CBR group, treatment completion was 90.0%, an absolute 10.8% higher than the clinic-based comparison group (79.2%, p = 0.02). Adherence was significantly greater in the CBR group than the clinic-based comparison group, as measured by self-report (p = 0.02) and urine isoniazid testing (p = 0.01). Among those not on ART at baseline, 10% of eligible PWH subsequently initiated ART. Community members living with HIV in TB endemic regions identified and referred for TPT demonstrated higher treatment completion and adherence compared to PWH engaged for TPT while receiving clinic-based care. Community-based identification and referral is an innovative adjunctive strategy to facilitate implementation of TB preventive therapy in people living with HIV. Competing Interests: The authors declare that they have no competing interests. SVS’s spouse previously worked for Merck Pharmaceuticals 1997-2007 and retains stock in his retirement account. There is no conflict of interest regarding this manuscript but it is included for full disclosure. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS policies on sharing data and materials. (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze:	MEDLINE
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