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Int J Tuberc Lung Dis. 2009 May;13(5):652-8.

Primary and secondary tuberculosis preventive treatment in HIV clinics: simulating alternative strategies.

Author information

1
Department of Epidemiology & Public Health, Yale University School of Medicine, New Haven, Connecticut, USA. sanjay.basu@yale.edu

Abstract

BACKGROUND:

Isoniazid preventive treatment (IPT) has been recommended for human immunodeficiency virus (HIV) infected individuals.

OBJECTIVE/DESIGN:

We used a mathematical model to simulate the benefits and risks of preventive treatment delivered through antiretroviral (ARV) clinics using clinical data from Botswana.

RESULTS:

Preventive treatment was found to reduce the incidence of tuberculosis (TB) by at least 12 cases per 100000 population per year versus the scenario without such treatment over a 50-year simulation. Isoniazid (INH) resistant TB was observed to increase by <1% per year, even when using pessimistic assumptions about resistance emergence. The use of tuberculin skin testing had little impact as a screening procedure, while secondary treatment was observed to nearly double the impact of a preventive treatment program. Regardless of whether or not preventive treatment was implemented, INH-resistant TB rose in the context of increasing HIV prevalence, but was minimally amplified by preventive treatment itself.

CONCLUSIONS:

IPT programs implemented through ARV clinics may be effective at reducing TB incidence. The resistance contribution of IPT appears unlikely to supersede its overall incidence and mortality benefits.

PMID:
19383201
[Indexed for MEDLINE]

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