14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrB1006

BACKGROUND: Interventions to limit the impact of HIV disease among working populations in Southern Africa are urgently required. We investigated the impact of primary preventive therapy with cotrimoxazole and isoniazid (IPT) given according to UNAIDS guidelines on the incidence of tuberculosis (TB) and other infections among HIV-infected mineworkers in South Africa.

METHODS: A "Prevention Clinic" (PC) was established in the health service of a mining company to provide care and preventive therapy to miners with HIV infection and/or silicosis. Employees with a previous positive HIV test were invited to join the clinic in random order over a two-year period; individuals could be referred early if clinically indicated. All episodes of TB and hospital admissions were identified from routine databases. A Poisson random effects model was used to compare incidence rates of TB and cotrimoxazole-preventable infections before and after recruitment to PC adjusting for age group, time period and individual frailty.

RESULTS: 2123 HIV-infected employees were included in the analysis. 59% attended PC at least once; the main reason for non-attendance was redundancy from the workforce. Mean age was 38 yrs. Preliminary data suggest that in the entire study population, the incidence rate (IR) of cotrimoxazole-preventable disease was reduced after recruitment to PC and this difference was significant in those aged >40yrs (IR post-PC 10/100pyrs, pre-PC 19/100pyrs; adjusted RR 0.59 (95%CI 0.41-0.83). There was no reduction in the incidence of TB (IR post-PC 13/100pyrs, pre-PC 12/100pyrs, adjusted RR 0.98 (95%CI 0.77-1.24).

CONCLUSIONS: Cotrimoxazole appears to be effective at preventing disease episodes though the effect was limited to older individuals who may be at a more advanced stage of disease. Implementation of the current UNAIDS policy on IPT did not reduce overall TB incidence. Further analysis will explore reasons for this.

Presenting author: Alison Grant

1London School of Hygiene & Tropical Medicine, Clinical Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London WCIE 7HT, United Kingdom.

2Aurum Health Research, Welkom, South Africa.

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