Tuberculosis preventive therapy in HIV-infected persons: feasibility issues in developing countries
Abstract:There is now strong evidence from several randomized controlled trials for the efficacy of preventive therapy in the prevention of tuberculosis in tuberculin skin test positive persons infected with the human immunodeficiency virus (HIV). The World Health Organization and the International Union Against Tuberculosis and Lung Disease recommend preventive therapy for tuberculin skin test positive, HIV-infected persons who do not have active tuberculosis. While implementation of preventive therapy is manageable in industrialised countries because it is affordable and the infrastructure is in place to screen, treat and monitor patients on a regular basis, its implementation in developing countries presents several problems. Feasibility issues such as identification of large numbers of HIV-infected persons, exclusion of active tuberculosis, identification of those most likely to benefit, supervision of preventive therapy and monitoring of adverse drug reactions need to be resolved before tuberculosis preventive therapy can be introduced on a larger scale in developing countries. Possible sites for implementation of a tuberculosis preventive therapy service include voluntary counselling and testing centres for HIV and occupational health clinics for military personnel, hospital or company workers. Feasibility studies need to be carried out to address these issues in developing countries.
Document Type: Review Article
Affiliations: 1: Centre for Respiratory Diseases Research, Kenya Medical Research Institute and Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK 2: Department of Medicine, University of Nairobi, Nairobi, Kenya
Publication date: August 1, 1999
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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