Operational assessment of isoniazid prophylaxis in an AIDS service organisation (TASO) in the community.
Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB276)
Lugada E, Gilks C, Nakiyingi JS, Whitworth JA, Neil F, Watera C, Mukasa-Monico S, Antivelink L E.Lugada, The AIDS Support Orginasation, PO Box 12777, Kampala, Uganda, Tel.: +256 77 507 410, Fax: +256 41 321 137, E-mail: ericlugada@yahoo.com
Back ground: Tuberculosis (TB) preventive therapy can reduce HIV related TB. Successful implementation in low income settings presents many problems. We set out to asses the operational aspects of a six month daily course of isoniazid (INH) therapy in HIV-1 , purified protein derivative (PPD) skin test positive attending a community based HIV/AIDS clinic in Entebbe, Uganda. Design: Of 1,640 HIV-1 positive adult clients of The AIDS Support Organisation (TASO) Entebbe, 195 PPD skin positives were screened for TB prophylaxis. They were educated emphasising compliance and consent was sought. Compliance was measured by monthly attendance, pill counting, self reported days of missed treatment and a random urine assay of INH metabolites. Defaulters were defined as late attendees of two or more weeks twice or late attendance over a month. Result: Of 195 HIV-1, PPD positives screened only 51% were legible for recruitment. 75% completed therapy with 20% defaulters, 3% died and 2% were treated for TB on clinical grounds. 88% INH urine metabolites were positive. About a third of the tests were spot checks at home, 85% tested positive compared to 89% positives in the clinics. 65% of those who completed therapy always kept their appointments to collect monthly pills for all the 5 scheduled visits. 81% had no pills left over on pill counting and 84% reported not to have missed their treatment through out the study.
CONCLUSION: Clinics like TASO specialised in the care of persons with HIV/AIDS can successfully implement INH prophylaxis with a screening mechanism in place. With proper medical screening however, only a minority of clients will be eligible.
