Date of Award
Open Access Thesis
Master of Public Health (MPH)
School of Public Health
INTRODUCTION: The HIV and TB co-epidemic remains a big obstacle in reducing PLHIV mortality and morbidity in Namibia. The solution to that has been the implementation of isoniazid preventative therapy (IPT) alongside ART for PLHIV to prevent the development of active tuberculosis. As newer shorter regimens of IPT (3HP) are released it is important to Namibia’s Ministry of Health to evaluate the efficacy of these newer IPT regimens prior to their implementation.
OBJECTIVES: The objective of this review is to compare the benefit of 3HP to that of 6-month or continuous (36-month) daily IPT for PLHIV to make future TB prophylaxis recommendations for MOH of Namibia. The review will take into consideration outcomes such as TB incidence, mortality, completion rate, and adverse events.
METHODS: The qualifying studies were randomized controlled trials which consisted of participants being provided with 3HP and daily IPT (6 month or continuous). Only studies that primarily enrolled PLHIV were included in this review. Out of all the results of these studies the interest is in the development of active tuberculosis, mortality, adverse events, and treatment completion rate.
RESULTS: The analysis of the two studies that qualified for this review informs us that 3HP has similar efficacy in preventing active tuberculosis to that of IPT. The Sterling study reported that discontinuation due to hepatotoxicity was significantly higher in the 9-month IPT arm (4%) than in the 3HP (1%) arm. Hepatoxicity was reported in 1.4% (3/207) of the participants in the 3HP group compared to 6.5% (12/193) of the 9-month IPT groups. Both studies reported a higher completion and adherence rate for 3HP than for 6-month or 9-month IPT. The highest adherence was reported for the 3HP in the Martinson study at 95.7% whereas 6-month IPT had an adherence rate for only 83.8%.
CONCLUSION: Largely, this review suggests that further research be done to evaluate the complexity of 3HP in different settings with different populations. However, based on these preliminary findings it is preferable for Namibia to adopt 3HP once it is cost-effective to raise their IPT completion rates, increase implementation of IPT in all local sites, and prevent adverse outcomes.
Bajpai, Anumita, "A Literature Review Of Current Tuberculosis Prophylaxis Strategies For Plhiv In Namibia" (2020). Public Health Theses. 1920.
This Article is Open Access