Guidelines for intensified tuberculosis case-finding and isoniazid ...

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The Guidelines Group noted that the data suggestingthe use of IGRA to identify latent TB in persons livingwith HIV are restricted to studies conducted in lowTB-prevalence settings and there is no evidence thatIGRA will determine who will benefit most from IPT.Based on the available data, the Guidelines Groupconcluded that IGRA are not recommended to screenpeople living with HIV for eligibility to receive IPT.2.4 Issues to consider for implementation of IPT2.4.1 Primary ownership by HIV service providersHIV treatment and care services shouldinclude a comprehensive approach topreventing, diagnosing and treating TBwith an emphasis on the Three I’s for HIV/TB. TheGuidelines Group concluded that providing IPT asa core component of HIV preventive care should bethe responsibility of national AIDS programmes andHIV service providers. In addition, IPT should notbe viewed as an isolated intervention and should bepart of a TB prevention package along with infectioncontrol for TB, ICF and the provision of early ARTto those with CD4 counts
varied widely from 34% to 98%, and a number offactors were identified to improve adherence.[40–44]The Guidelines Group noted that, althoughtreatment completion is important for goodindividual and programme outcomes, the primaryobjective should be to ensure that people do notcontinue to take IPT in the rare instance of activeTB or development of toxicity. People living withHIV and receiving IPT should have regular clinicalfollow up based on the national, local and clinicalcontext. This includes regular screening usingthe TB symptom-based rule during every contactwith a health-care provider. The Guidelines Groupnoted that the co-formulation of INH with otherdrugs (e.g. ART or CPT) could reduce the pillburden and enhance adherence, and called forexpedited development of such co-formulations.The Guidelines Group strongly recommends thatconcerns regarding adherence should not be abarrier to implementing IPT.2.4.4 Cost-effectiveness of IPTThe Guidelines Group concluded that theavailable data on the cost-effectiveness of IPT isof low quality with significant variability betweenoutcome measures, assumptions and analyticalprocedures (Annex 12). It was recognized that thisis an area that requires additional research to betterinform programmatic decision-making. However,after a review of the evidence, the Guidelines Groupstrongly recommends that the provision of IPT islikely to be cost-effective. This supports the overallrecommendation for the wide use of IPT withincomprehensive HIV prevention, care and treatmentservices, both as a measure of good clinical practiceand as a likely cost-effective measure.21
Page 1 and 2: Guidelines for intensifiedtuberculo
Page 5: Summary of declarations of interest
Page 10 and 11: 7Providing IPT to people living wit
Page 12 and 13: 1.3 ScopeThe guidelines present a s
Page 14: Strength of recommendationStrongCon
Page 17 and 18: 2.2.2.1 Table 1: Comparison of the
Page 19: 2.3 Detecting latent TB infection i
Page 23 and 24: study showed that the absence of co
Page 25 and 26: Encouraging data show that IGRA are
Page 27 and 28: 4.3 Operational research• Potenti
Page 29 and 30: Medicine, 1994, 9:695-721.31. Marko
Page 31 and 32: GRADE profile table 2: TB screening
Page 33 and 34: No. of patientsSummary of findingsE
Page 36: GRADE profile table 5: Efficacy of
Page 39 and 40: No. of patientsSummary of findingsE
Page 41 and 42: Continuous INHprophylaxisNo. of pat
Page 44 and 45: GRADE profile table 9: Efficacy in
Page 46 and 47: GRADE profile table 10: Drug resist
Page 48: Bibliography1. Ayles H et al. Preva

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