AEGiS-14IAC: Feasibility of tuberculosis preventive therapy and cotrimoxazole prophylaxis in South African TB/HIV pilot districts.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Feasibility of tuberculosis preventive therapy and cotrimoxazole prophylaxis in South African TB/HIV pilot districts.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10244)

Hausler HP, Naidoo P, Karpakis B, Pronyk P, Campbell L, Colvin M, Sallet J, Sheard C, Matji R, Simelela N, Godfrey-Faussett P
Chief Directorate: HIV/AIDS & Tuberculosis, Department of Health and London School of Hygiene and Tropical Medicine, Pretoria, South Africa

BACKGROUND: The convergence of HIV and tuberculosis has led to a rapid increase in TB incidence in South Africa. The Department of Health established 4 TB/HIV Pilot Districts in 1999 to address the dual TB/HIV epidemic by implementing and evaluating a comprehensive package of TB/HIV/STI prevention, care and support in collaboration with the WHO/UNAIDS ProTest Initiative.

METHODS: 141 primary health care nurses were trained to provide rapid HIV testing and comprehensive TB/HIV/STI clinical care. Tuberculosis preventive therapy (TBPT) (isoniazid 300 mg daily for 6 months) was provided for HIV-positive clients with no symptoms of TB. Cotrimoxazole prophylaxis (480-960 mg daily for life) was provided for HIV-positive clients with WHO clinical stage 3 or 4. Prophylaxis was self-administered and clients were followed monthly to monitor adherence and side effects.

RESULTS: Over a period of approximately 15 months there were 3236 HIV-positive clients screened and 1303 (40%) started on TBPT in 3 districts combined. Adherence to 6 months of TBPT for people started in the third quarter of 2000 varied from 13% in Ugu South to 46% in Bushbuck Ridge to 63% in Central District. Over the same period, there were 2320 HIV-positive clients screened and 404 (17%) started on cotrimoxazole prophylaxis. Adherence to 6 months of cotrimoxazole prophylaxis for people started in the third quarter of 2000 varied from 5% in Ugu South to 32% in Bushbuck Ridge to 64% in Central District. There were very few adverse reactions to either isoniazid or cotrimoxazole. In Central District, 6 (1.4%) of 434 clients on cotrimoxazole and 9 (5%) of 173 clients on isoniazid developed adverse reactions.

CONCLUSIONS: Although it is feasible to provide ongoing clinical care to people living with HIV in resource-constrained settings, adherence to prophylactic regimens is low and varies between districts. Further research is required to determine what interventions and support systems will improve adherence.

Keywords: AEGIS, Trimethoprim-Sulfamethoxazole Combination, Tuberculosis, HIV Infections, HIV Seropositivity, Isoniazid, Incidence, Antiretroviral Therapy, Highly Active, Self Administration, South Africa, Human, prevention & control, therapy, drug therapy

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B10244