Aids Weekly Plus
According to Richard Chaisson, MD, study researcher and director of the Center for Tuberculosis Research at Johns Hopkins University, routine TB testing in HIV-infected individuals and use of preventive isoniazid worked at the community level in stopping TB transmission and reducing mortality.
Chaisson and colleagues conducted a cluster-randomized trial with 12,816 patients ages 16–84 years at 29 HIV clinics in Brazil. The researchers selected the clinics at random times to use an intervention that included training staff to screen HIV-infected patients for TB, administer TB skin tests, and treat latent TB infection. During the study, 475 patients developed TB and 838 patients died. Due to the intervention, more patients received skin tests, 19 per 100 person-years to 59 per 100 person-years. In participants eligible for isoniazid therapy, the rate increased from 36 per 100 person-years to 144 per 100 person-years.
After the intervention, researchers noted a 24-percent decrease in TB or death and a 13-percent decrease in new TB cases. When researchers controlled for characteristics such as age, sex, CD4 count, and use of antiretroviral therapy, they found a 31-percent decrease in TB or death and a 27-percent decrease in new TB cases. Analysis of patients who remained in contact with a clinic showed a 55-percent decrease in TB or death and a 58-percent decrease in active TB.
According to researchers, initial TB screening as part of the intervention diagnosed TB in 250 of 725 participants. They were excluded from analyses. Johns Hopkins Epidemiologist Jonathan Golub, PhD, MPH stated that the results emphasized the effectiveness of TB screening in community health programs similar to the program used in the study and that the findings showed that HIV-infected patients benefited if healthcare providers screened them for active and latent TB and treated, and those benefits affected disease and mortality in the HIV population.
The full report, “Effect of Improved Tuberculosis Screening and Isoniazid Preventive Therapy on Incidence of Tuberculosis and Death in Patients with HIV in Clinics in Rio de Janeiro, Brazil: A Stepped Wedge, Cluster-Randomised Trial,” was published online in the journal Lancet Infectious Diseases (2013; doi: 10.1016/S1473-3099(13)70187-7).