Results from a new study in Brazil show that not only is tuberculosis (TB) preventive treatment safe and effective, but it also delivers significant benefits at the community level.
Announced at the 2011 International AIDS Conference in Rome, the THRio (TB and HIV in Rio) study investigators implemented clinical staff training on the importance of preventing TB in people living with HIV, and teaching doctors and nurses how to perform testing for TB infection. Scientists at Rio de Janeiro Municipal Health Secretariat in Brazil and the John Hopkins University studied these interventions in 29 clinics in Rio de Janeiro, including almost 13,000 HIV-positive patients, to determine the impact of isoniazid preventive therapy (IPT) on rates of TB and death in that population.
The intervention had a modest impact (13 percent reduction) on TB incidence, but showed an important and statistically significant impact on TB and death that might be attributed to TB (28 percent reduction).
“The THRio study results show a reduction in TB and death among our HIV patients in a ‘real world’ scenario rather than in a more structured clinical trial, even with the many obstacles faced when implementing this important intervention,” said the study’s Principal Investigator Dr. Bettina Durovni of the Rio de Janeiro Municipal Health Secretariat.
What is more, those receiving consistent care experienced a 43 percent reduction in TB incidence and a 44 percent reduction in TB or death that might be attributed to TB. A previous release of study results from THRio showed the high effectiveness of IPT to the individual, but these results show the population-level benefit.
The study also notes the unusually high adherence to treatment experienced, with 80 percent of patients in this community completing the full six-month course of treatment. “In the U.S., almost half of patients started on IPT never complete the treatment according to some studies,” according to a press release by the Consortium to Respond Effectively to the AIDS TB Epidemic (CREATE), who funded the study.
At the International AIDS Conference in Rome, Dr. Valeria Saraceni presented on the study and said it was important to note that although it is recommended by the Brazilian Ministry of Health to use IPT in people living with HIV, the policy has been poorly implemented, providing an impetus for this research.