Research presented at Union World Conference shows the power of preventive therapy in tackling TB-HIV

On World AIDS Day, we reflect on the importance on preventive therapy in tackling TB-HIV, as highlighted in two studies presented at the 49th Union World Conference on Lung Health, in The Hague, The Netherlands. Isoniazid preventive therapy (IPT) is a life-saving intervention aimed at preventing TB in people living with HIV (PLHIV).

An analysis of early-phase implementation of IPT for PLHIV in Malawi found the treatment to be effective, supporting the move for Malawi in late 2017 to scale-up IPT in the five highest TB-HIV-burden districts.

The 2018 World Health Organization Global TB Report ranks Malawi amongst the top twenty high TB/HIV burden countries, with close to half of TB patients co-infected with HIV. The aim of the two-stage cluster survey was to measure the frequency and timeliness of early-phase IPT uptake in a programmatic setting.

The study sampled 271 new-to-care people living with HIV. The overall weighted uptake of the therapy was 70 percent, of which 82 percent continued IPT at the follow-up visit.

Laurence Gunde of the Centers for Disease Control and Prevention in Lilongwe, Malawi, presented the results and also noted excellent timeliness of early assessments and therapy of TB. As 96 percent started antiretroviral therapy (ART) within one week of HIV diagnosis, and 91 percent of IPT starts occurred on the same day the person began ART.

He said: “These results demonstrate an effective early-phase scale-up of IPT among new-to-care PLHIV in Malawi, which may serve as a model for similar national programmes. Malawi also underscores the utility of early assessments, as doing so can lead to prompt quality improvement interventions.”

Read the abstract and download the presentation: Early-phase implementation success of isoniazid preventive therapy for people living with HIV - Malawi, 2017

The second study found that 99 percent of participants being treated with IPT at five HIV care facilities in eSwatini (formerly Swaziland) reported that being offered a choice was important to their treatment completion.

The prospective cohort study was conducted to determine an effective model for IPT delivery using patient preferences. Patients participating in the study were given a choice between community-based or facility-based treatment. In addition, IPT was linked with antiretroviral therapy pick-up, and healthcare workers were trained in motivational interviewing skills to help providers learn what mattered most to patients and what might help their behaviour to change.

Despite the fact that the majority of patients chose facility based treatment (the traditional method for medicine delivery), patients reported that the fact they were provided a choice made a difference in their motivation to see treatment through to completion.  The choice between the two methods of delivery was especially important to study participants living in rural areas who benefited greatly from having improved access to medications and reducing travel time.

The study also found that 95 percent of participants disclosed to friends or family that they were undergoing preventive treatment for TB and participating in a study.

The next step, following the release of this data, to scale up the strategy nationwide and to create an IPT toolkit to aid in medicine distribution and facility adherence.

Read the abstract and download the presentation: Integrated care and patient choice enable treatment completion of isoniazid preventive therapy in Swaziland