Interventions for Tuberculosis Control and Elimination 2002

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a small fraction was actually referred for evaluation of eligibility for preventive
chemotherapy. Quite obviously, the collaboration was poor despite
the study setting. Additional patients were lost for tuberculin testing and
reading, only a fraction of these were actually eligible for preventive
chemotherapy, and not all of those who were eligible were actually adherent.
Only three per cent of the initial cohort completed preventive
chemotherapy, and the efficacy was never assessed.
Indications and recommendations for the use
of preventive chemotherapy
It is apparent that the place preventive chemotherapy will have within the
context of a national tuberculosis control program will depend foremost on
the epidemiologic situation and on the availability of resources. Rapid
improvement in the epidemiologic situation and sufficient resources often
go together, while the reverse is also the case. 906
In industrialized countries embarking on strategies to eliminate tuberculosis,
preventive chemotherapy will play an important role, yet the situation
is rather different in countries with a high or even increasing tuberculosis
burden where resources are very tight even to secure the treatment
of all known cases of bacteriologically confirmed tuberculosis.
Within the context of resource availability, it should be considered that
the costs for isoniazid are probably of least concern in most settings.
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Figure 89. Operational feasibility of preventive therapy usage in a voluntary counseling
and testing site for HIV infection. 905