16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

CHARACTERISTICS OF PEOPLE LIVING WITH HIV-1 (PLWH) SCREENED FOR ISONIAZID PREVENTIVE THERAPY (IPT) - BOTSWANA, 2004-2005

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAb0102

Samandari T.¹, Mosimaneotsile B.², Nyirenda S.³, Agizew T.², Motsamai O.⁴, Kilmarx P.H.⁵, Talbot E.A.⁶, Wells C.D.^6
1CDC/BOTUSA, Division of TB Elimination, Gaborone, Botswana, ²BOTUSA, Gaborone, Botswana, ³BOTUSA, Francistown, Botswana, ⁴Ministry of Health, National TB Programme, Gaborone, Botswana, ⁵CDC, Division of HIV/AIDS Prevention, Atlanta, United States, ⁶CDC, Division of TB Elimination, Atlanta, United States

BACKGROUND: IPT aims to prevent active tuberculosis (TB) among PLWH in TB-endemic countries. Because of high rates of both TB and HIV, Botswana rolled out an IPT program nationwide by mid-2004. This analysis aims to better inform national IPT programs about characteristics of PLWH seeking IPT from data derived from an ongoing clinical trial that recruited at the same sites as the Botswana National IPT Program.

METHODS: PLWH were referred largely from local clinics and voluntary counseling and testing centers, and were screened in two parts. First-round screening followed guidelines set by Botswana’s National IPT Program; exclusion criteria included any current illness, terminal AIDS, or recent TB treatment. If not excluded, candidates underwent second-round (trial-related) screening: exclusion criteria included abnormal chest radiographs (CXRs), elevated hepatic enzymes, significant neutropenia, or anemia.

RESULTS: Between January-December 2005, 3,458 persons (65% female; median age 33 years) underwent first-round screening. Of these, 987 (28%) were excluded; the most frequent reasons were current illness (51%) and recent TB treatment (8%). Of the PLWH who underwent first-round screening, 2,261 persons (65%) proceeded to second-round screening. Of these 511 (23% of second-round subjects) were excluded; the most frequent reasons were abnormal CXRs (50%) and neutropenia (20%). Of the original 3,458 who underwent first-round screening, 1,499 (43%) were enrolled for the trial. Among enrollees, 25% had tuberculin skin tests with >5 mm induration, median CD4 lymphocyte count was 313 cells/mm³ and 18% were already receiving highly active antiretroviral therapy.

CONCLUSIONS: Many PLWH seeking IPT in Botswana have advanced HIV disease, and were ineligible for IPT due to current illness at first-round screening or an abnormal CXR in second-round screening. As these exclusions were most likely related to advanced HIV disease, national IPT programs may best target candidates for IPT by targeting HIV screening to healthier individuals.

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2006-08-13
MoAb0102

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