Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Impact of isoniazid preventive therapy for HIV-infected adults in Rio de Janeiro, Brazil: an epidemiological model

TitleImpact of isoniazid preventive therapy for HIV-infected adults in Rio de Janeiro, Brazil: an epidemiological model
Publication TypeJournal Article
Year of Publication2014
AuthorsDowdy, DW, Golub, JE, Saraceni, V, Moulton, LH, Cavalcante, SC, Cohn, S, Pacheco, AG, Chaisson, RE, Durovni, B
JournalJ Acquir Immune Defic Syndr
Date PublishedAug 15
ISBN Number1525-4135
Accession Number24853308
KeywordsAdolescent, Adult, Anti-HIV Agents/*therapeutic use, Antitubercular Agents/administration & dosage/*pharmacology, Brazil/epidemiology, HIV Infections/complications/*drug therapy/transmission, Humans, Isoniazid/administration & dosage/*pharmacology, Middle Aged, Sexual and Reproductive Health, Tuberculosis/*prevention & control/transmission, Urban Population, Young Adult

BACKGROUND: The potential epidemiological impact of isoniazid preventive therapy (IPT), delivered at levels that could be feasibly scaled up among people living with HIV (PLHIV) in modern, moderate-burden settings, remains uncertain. METHODS: We used routine surveillance and implementation data from a cluster-randomized trial of IPT among HIV-infected clinic patients with good access to antiretroviral therapy in Rio de Janeiro, Brazil, to populate a parsimonious transmission model of tuberculosis (TB)/HIV. We modeled IPT delivery as a constant process capturing a proportion of the eligible population every year. We projected feasible reductions in TB incidence and mortality in the general population and among PLHIV specifically at the end of 5 years after implementing an IPT program. RESULTS: Data on time to IPT fit an exponential curve well, suggesting that IPT was delivered at a rate covering 20% (95% confidence interval: 16% to 24%) of the 2500 eligible individuals each year. By the end of year 5 after modeled program rollout, IPT had reduced TB incidence by 3.0% [95% uncertainty range (UR): 1.6% to 7.2%] in the general population and by 15.6% (95% UR: 15.5% to 36.5%) among PLHIV. Corresponding reductions in TB mortality were 4.0% (95% UR: 2.2% to 10.3%) and 14.3% (14.6% to 33.7%). Results were robust to wide variations in parameter values on sensitivity analysis. CONCLUSIONS: TB screening and IPT delivery can substantially reduce TB incidence and mortality among PLHIV in urban, moderate-burden settings. In such settings, IPT can be an important component of a multi-faceted strategy to feasibly reduce the burden of TB in PLHIV.