Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control

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dc.contributor.authorChurchyard, Gavin J
dc.contributor.authorChaisson, Richard E
dc.contributor.authorMaartens, Gary
dc.contributor.authorGetahun, Haileyesus
dc.date.accessioned2021-10-08T07:20:31Z
dc.date.available2021-10-08T07:20:31Z
dc.date.issued2014
dc.description.abstractTuberculosis (TB) remains a global health problem, and South Africa (SA) has one of the world's worst TB epidemics. The World Health Organization (WHO) estimated in 1999 that one-third of the world's population was latently infected with TB. In SA up to 88% of HIV-uninfected young adults (31 - 35 years) are latently infected with TB. In the most recent meta-analysis, 6 - 12 months of isoniazid preventive therapy (IPT) was associated with a lower incidence of active TB than placebo (relative risk (RR) 0.68; 95% confidence interval (CI) 0.54 - 0.85), with the greatest benefit among individuals with a positive tuberculin skin test (TST) (RR 0.38; 95% CI 0.25 - 0.57). A clinical trial of IPT given with antiretroviral therapy (ART) for 12 months reduced TB incidence by 37% compared with ART alone (hazard ratio (HR) 0.63; 95% CI 0.41 - 0.94). The effect of IPT is limited in high-burden countries. IPT for 36 months v. 6 months reduced TB incidence among HIV-positive, TST-positive participants by 74% (HR 0.26; 95% CI 0.09 - 0.80). A study of more than 24 000 goldminers confirmed that IPT is safe, with only 0.5% experiencing adverse events. A meta-analysis of studies of IPT since 1951 did not show an increased risk of developing resistance. Alternative TB preventive therapy regimens, including high-dose isoniazid and rifapentine given weekly for 3 months, have been shown to have similar efficacy to IPT. Mathematical modelling suggests that scaling up continuous IPT targeted to HIV-positive persons, when used in combination with other treatment and prevention strategies, may substantially improve TB control.
dc.identifier.apacitationChurchyard, G. J., Chaisson, R. E., Maartens, G., & Getahun, H. (2014). Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control. <i>South African Medical Journal</i>, 104(5), 339 - 177. http://hdl.handle.net/11427/34940en_ZA
dc.identifier.chicagocitationChurchyard, Gavin J, Richard E Chaisson, Gary Maartens, and Haileyesus Getahun "Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control." <i>South African Medical Journal</i> 104, 5. (2014): 339 - 177. http://hdl.handle.net/11427/34940en_ZA
dc.identifier.citationChurchyard, G.J., Chaisson, R.E., Maartens, G. & Getahun, H. 2014. Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control. <i>South African Medical Journal.</i> 104(5):339 - 177. http://hdl.handle.net/11427/34940en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Churchyard, Gavin J AU - Chaisson, Richard E AU - Maartens, Gary AU - Getahun, Haileyesus AB - Tuberculosis (TB) remains a global health problem, and South Africa (SA) has one of the world's worst TB epidemics. The World Health Organization (WHO) estimated in 1999 that one-third of the world's population was latently infected with TB. In SA up to 88% of HIV-uninfected young adults (31 - 35 years) are latently infected with TB. In the most recent meta-analysis, 6 - 12 months of isoniazid preventive therapy (IPT) was associated with a lower incidence of active TB than placebo (relative risk (RR) 0.68; 95% confidence interval (CI) 0.54 - 0.85), with the greatest benefit among individuals with a positive tuberculin skin test (TST) (RR 0.38; 95% CI 0.25 - 0.57). A clinical trial of IPT given with antiretroviral therapy (ART) for 12 months reduced TB incidence by 37% compared with ART alone (hazard ratio (HR) 0.63; 95% CI 0.41 - 0.94). The effect of IPT is limited in high-burden countries. IPT for 36 months v. 6 months reduced TB incidence among HIV-positive, TST-positive participants by 74% (HR 0.26; 95% CI 0.09 - 0.80). A study of more than 24 000 goldminers confirmed that IPT is safe, with only 0.5% experiencing adverse events. A meta-analysis of studies of IPT since 1951 did not show an increased risk of developing resistance. Alternative TB preventive therapy regimens, including high-dose isoniazid and rifapentine given weekly for 3 months, have been shown to have similar efficacy to IPT. Mathematical modelling suggests that scaling up continuous IPT targeted to HIV-positive persons, when used in combination with other treatment and prevention strategies, may substantially improve TB control. DA - 2014 DB - OpenUCT DP - University of Cape Town IS - 5 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2014 SM - 0038-2469 T1 - Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control TI - Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control UR - http://hdl.handle.net/11427/34940 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34940
dc.identifier.vancouvercitationChurchyard GJ, Chaisson RE, Maartens G, Getahun H. Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control. South African Medical Journal. 2014;104(5):339 - 177. http://hdl.handle.net/11427/34940.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue5
dc.source.journalvolume104
dc.source.pagination339 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.8290
dc.subject.otherAntitubercular Agents
dc.subject.otherHumans
dc.subject.otherIncidence
dc.subject.otherIsoniazid
dc.subject.otherRisk Reduction Behavior
dc.subject.otherSouth Africa
dc.subject.otherTuberculosis
dc.subject.otherAntitubercular Agents
dc.subject.otherIsoniazid
dc.titleTuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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