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AIDS. 2018 Sep 24;32(15):2129-2140. doi: 10.1097/QAD.0000000000001959.

Modeling the implementation of population-level isoniazid preventive therapy for tuberculosis control in a high HIV-prevalence setting.

Author information

1
Department of Biology.
2
Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine.
3
Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA.

Abstract

BACKGROUND:

We model the epidemiological impact of providing isoniazid preventive therapy (IPT) to South African adolescents, among whom HIV prevalence is low, latent tuberculosis (TB) prevalence is high, and school-based programs may enable population-level coverage.

METHODS:

We simulate a dynamic compartmental model of age-structured HIV and TB coepidemics in South Africa. HIV dynamics are modeled by infection status, CD4 cell count, and antiretroviral therapy; TB dynamics are modeled by disease stage, diagnosis, treatment, and IPT status. We analyze the effects of continuous IPT coverage among adolescents from 5 (baseline) to 90%.

RESULTS:

Our model is calibrated to WHO and the Joint United Nations Programme on HIV/AIDS epidemiological estimates. In simulations, increasing IPT coverage to 50% among adolescents reduced active TB incidence by 5-34%. Increasing coverage to 90% led to a 9-40% reduction in active TB incidence. Expanded IPT access causes TB incidence to decline in the general population of HIV-positive individuals, as well as in adult HIV-positive individuals.

CONCLUSION:

Targeting IPT to a secondary school population with high latent TB prevalence and low-HIV prevalence, in which risk of false-negative diagnosis of active TB is low and IPT benefits are more established, could have substantial benefits to adolescents and spillover benefits to the adult population.

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